What about driving when you have psychogenic non-epileptic seizures (PNES)?

You may have been unaware until you developed PNES that there are a few medical conditions that can result in the suspension of someone’s driver’s license. These include epilepsy (seizures) and even though PNES is not epilepsy, some people who have PNES may lose consciousness or may lose control of parts of their body or all during an episode. Understandably, this can be dangerous if it happens while driving.  This is why if a patient’s seizures might result in impaired driving, the patient should stop driving until the episodes are under control. Just when this post was being written, a tragic news story appeared regarding a fatal accident involving a driver diagnosed with PNES (Abby Michaels trial recesses after closing arguments: Day 4 (wdtn.com)) which was a chilling reminder as to the importance of this issue.

Note: Self driving vehicles may represent an important addition to the lives of persons living with seizures since this prohibition might become a thing of the past. However, the research on these self-driven vehicles is still in the earlier stages.

Typically, the Department of Motor Vehicles oversees these driving restrictions but regulations regarding seizures vary from state to state and obviously from country to country.  This is why I usually recommend to a patient or family member to search for “driving regulations and seizures” in the patient’s locality.

It is important also to be aware that there are 5 states in the USA (California, Delaware, Nevada, New Jersey, Oregon) where doctors are mandated to report a patient to the DMV as soon as the patient informs the doctor that he/she has had a seizure.  When that happens, the doctor is obligated to contact the DMV that very same day and the DMV officially suspends the patient’s license. There are different lengths of suspension and depend on the number of months of seizure-freedom required by that state (e.g., 3, 6 12 months).  As you may have suspected, there is no real scientific foundation for the duration of the suspension which is why you see the widely different lengths from state to state.  Also, sometimes the DMV will consider if someone’s seizures don’t appear to pose a threat while driving (e.g., only occur at night, are always preceded by a lengthy aura, etc.) and choose to make exceptions to their driving prohibition. But this is not guaranteed.

Losing driving privileges, especially in parts of the country where driving is a necessity (which is actually almost everywhere except for some of the major cities), can radically change someone’s life and become a hardship. During the early stages of PNES, patients and their healthcare team are recommended to brainstorm and come up with some useful solutions (e.g., public transportation, walking, enlisting a friend or relative to drive you, carpooling, local paratransit options, or an online car service-although the latter can be pricey, etc.). But truly, it is essential that appropriate treatment is started as soon as possible so the patient can achieve seizure-freedom. Scientifically supported treatments for PNES include cognitive behavioral therapy (CBT), mindfulness-based treatment (MBT), and prolonged exposure (PE) for example. Unlike other functional neurological disorders, non-epileptic seizures are not treated with physical therapy, speech therapy or occupational therapy and psychopharmacological treatments are usually adjunctive.

A recent quick retrospective review of a few years of patient records in our epilepsy program revealed that around 25% of charts included the necessary paperwork requesting the doctor’s office submit DMV paperwork for driving privileges to resume. This number is likely an underestimate due to different regulations in different states but is clearly positive because it shows that one fourth of patients were documenting seizure-freedom for at least 6 months and were also feeling ready to start driving again; and with driving comes greater independence, job and educational opportunities and more.

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