CONTRIBUTION Driving Policy after Seizures and Unexplained Syncope: A Practice Guide for RI Physicians MAXWELL E. AFARI, MD; ANDREW S. BLUM, MD, PHD; STEPHEN T. MERNOFF, MD; BRIAN R. OTT, MD ABSTRACT Physicians in Rhode Island sometimes find it difficult to advise patients about returning to driving after they present with a seizure or syncopal episode due to lack of statutory or professional guidance on the issue. We provide an overview of the medical literature on public policies and recommendations regarding driving after seizures or syncope. We also present the laws in Rhode Island regarding physician notification of the medical ad- visory board of the Department of Motor Vehicles, legal obligations, and immunity from prosecution for those who report. Finally, we present the results of a survey of current practice by Rhode Island neurologists when they advise patients who have had a recent seizure or unex- plained syncopal event. Based upon this information, we hope local practitioners are empowered in their decision making on driving restrictions and we hope this data informs future public policy efforts. KEYWORDS: driving recommendations, seizures, unexplained syncope INTRODUCTION Many physicians find it difficult to prescribe driving rec- ommendations to patients who present with seizure or un- explained syncope. Some of the questions that arise include: How long should drivers stay off the road? After prescribing restrictions, are physicians obliged to report this to state au- thorities? And if a physician chooses to notify the authori- ties, is the physician immune from prosecution for breaking confidentiality? The last review article on driving policies and physicians relevant to Rhode Island was published over a decade ago. 1 The current article provides an update to this review and reports the first survey of neurologists on their current driving-related practices in our state. METHODS Academic neurologists and members of the Rhode Island Neurological Society (RINS) and Rhode Island Neurology Association (RINA) were invited to participate in an on- line survey about driving recommendations post syncope or seizure. Different scenarios were created and physicians chose from six possible driving restriction durations: No restriction, 3 months, 6 months, 12 months, 18 months, other (with explanation). The questions asked are presented in Table 1. RESULTS According to RINS/RINA/AAN records there are approxi- mately 60 practicing neurologists in RI, and most of them were contacted to complete the survey. Thirty neurologists, representing approximately 50% of practicing neurologists in Rhode Island, responded to the survey. As demonstrated in Table 2, in the setting of a first seizure with loss of con- sciousness, more than half of the respondents recommended a 6-month driving restriction irrespective of an identified seizure focus (70.0 %) or normal EEG and MRI (63.3%). Sur- prisingly, half (50.0%) of the surveyed neurologists were in favor of 6 months driving restrictions even with seizure pre- sentations without loss of body control. Respondents showed consensus when questioned about patients with nocturnal seizures. Eighteen neurologists rep- resenting 60% of respondents were in favor of a 6-month driving restriction; 16.7% (5) respondents chose “Other” and some of the explanations given included: “It depends how well established the nocturnal seizure pattern is;” “Do not drive at night;” and “If not first ever event and well documented only at night, would not restrict.” How would you advise a patient who: Presents with a first seizure (complex partial or with loss of consciousness) but has a normal EEG and MRI? Presents with first seizure (complex partial or with loss of consciousness) and has an identified seizure focus? Presents with first partial seizure that does not affect awareness or bodily control? Presents with only nocturnal seizures? Is suspected of having psychogenic or non-epileptic seizures with loss of consciousness or bodily control? Presents with unexplained syncopal episode with normal EEG and cardiac monitor? Table 1. Online survey questions posed to neurologists in Rhode Island. EEG: Electroencephalography, MRI: Magnetic resonance imaging RHODE ISLAND MEDICAL JOURNAL WWW.RIMED.ORG | RIMJ ARCHIVES | JANUARY WEBPAGE 40 JANUARY 2014