Dubai: People who suffer from a medical condition that can trigger an episode that potentially impacts their cognitive abilities or causes a loss of consciousness must desist from driving, say medical experts. These conditions include epilepsy, heart disease, diabetes and susceptibility to strokes.

The relationship between medical conditions and driving came into focus again due to the accident in Ajman on Sunday night when a 22-year-old Emirati crashed into a restaurant during an epileptic seizure. Two people died and five were injured in the crash.

Dr Arun Kumar Sharma, specialist neurologist, Medeor 24X7 hospital, Dubai, said they usually follow up on at least five-six epilepsy cases each day and at least two new cases each week.

“There are at least ten different kinds of epileptic conditions. Epilepsy is manifested by a brief electrical dysfunction in brain activity which causes cessation of the normal electrical brain pattern. When a person has more than two seizures in his life which are unprovoked by any injury or illness like meningitis, it is diagnosed as idiopathic epilepsy. Usually, epilepsy is marked by two phases — tonic and clonic. Tonic phase includes a kind of an aura where the patient has an innate sense of an impending seizure where his body twists and goes stiff. This can last for 30 seconds followed by the actual clonic seizure which can be severe twitching and a possible loss of consciousness.”

It is not advisable for an epileptic patient, who is under medication, to drive a car as an active seizure can be triggered if he has missed a dosage. An active seizure can also be triggered, for example, by traffic stress or ingestion of extra caffeine, such as when drinking Red Bull.

Although there is uncertainty about the onset of a epileptic seizure, Dr Sharma said modern diagnosis and new age medicines have made it possible for a patient to become seizure-free with prolonged treatment.

“Usually, if a patient has his medication as per the prescribed doses, he can successfully, and completely, avoid a seizure. About 80-90 per cent of epilepsy cases can be controlled with medication. Once a patient has been seizure-free for five years, the physician can gradually taper off the dosage until he can be medication-free,” said Dr Sharma.

Dr Sharma added that unpredictability about a seizure is always a concern and patients in the early years of their treatment should not be allowed to drive. “In countries such as the US, the UK and Australia, patients under treatment for epilepsy are not allowed to drive. For a personal driving licence in the US, for example, a patient has to be seizure-free for at least five years. In the case of commercial driving, a patient has to be at least 10 years seizure-free [after treatment] to be able to get a driving licence.”

Dr Sharma added that in the US, a physician is bound by law to notify the Department of Motor Vehicles (DMV) at least in six states whereas in the rest of the states, a patient has to mandatorily volunteer the information to the DMV.

According to a study conducted by the Johns Hopkins University in 2004, of more than 45,000 traffic fatalities, only 0.02 per cent were attributed to epileptic drivers indicating the law was working well.

Dr Sharma said he was not aware if the Roads and Transport Authority (RTA) had such a direct link with hospitals and physicians to receive notifications. “This is a topic of medical and epidemiological interest and intensive public policy research. Certain medical risk conditions [for the patient and those around him] must be notified to the authorities. These include heart conditions [where a patient can have a heart attack owing to traffic stress], diabetes [where a patient who can have a case of hypoglycaemia or low blood sugar triggering disorientation, loss of cognitive abilities and even diabetic coma] and elderly people at the risk of brain stroke due to a blood clot.”



Precautions to take for medical conditions

1. Create awareness among patients. They need to be made aware of the risks to themselves and to others. Individuals with epilepsy should be made to understand that it is only safe to drive when they have been seizure-free for at least five years.

2. Epileptic patients under medication must avoid smoking and highly caffeinated drinks. They must be regular with medication and also inform the authorities of their condition.

3. In case of diabetics, they can keep dates and candy in the car and check their blood sugar before getting behind the wheel. In case it is low, this can be instantly remedied.

4. For patients prone to heart condition or strokes, they are fairly safe if they take their medications, and aspirin, regularly, and are undergoing regular check-ups.

— Dr Arun Kumar Sharma, specialist neurologist, Medeor 24X7 hospital, Dubai