In January of this year, Pennsylvania state regulators approved a shorter driving restriction following a seizure, from six months to three months. The rule went into effect in March.
It primarily affects those with epilepsy, many of whom can drive when their condition is well-controlled through medication or other treatments. The suspension is triggered only when a person experiences a breakthrough seizure.
The change continues a decades-long trend toward shorter suspension periods in the state. When the regulation was originally set in 1979, drivers faced a 12-month suspension following a seizure. The period was reduced to six months in 2004, where it remained until this year's revision.
The update came in part from the efforts of Allegheny Health Network's System Vice Chair for the Department of Neurology, Dr. Andrea Synowiec, who is a member of the PennDOT Medical Advisory Board. She has championed a decrease to what she called "an outdated regulation" since the start of her now six-year tenure on the board.
"The data suggests that you are just as safe on the road with this regulation change as you were before, maybe safer," she said. "In fact, you've got a lot more people who are willing to do what they're asked to do because the restrictions are not so onerous."
The Medical Advisory Board reviewed data from Arizona, which the state studied when it reduced its restrictions in 1994. It showed that the rate of seizure-related crashes did not significantly increase after reducing the suspension from 12 months to three months and fatalities even decreased.
The regulation now also aligns with a position from the American Academy of Neurology (AAN) and various epilepsy advocacy groups. The group affirmed that a three-month seizure-free requirement, along with an individualized risk assessment by the patient's doctor, is safest.
But one aspect of the Pennsylvania regulation is actually in conflict with the AAN's guideline. Physicians are still required to report their patients' breakthrough seizures to the Pennsylvania Department of Transportation (PennDOT).
In contrast, AAN recommends that doctors be allowed, but not required, to report drivers at elevated risk. They note that mandatory reporting by healthcare providers, "does not reduce accidents or fatalities but does increase the likelihood of people driving without a license and withholding information about seizures from their doctors."
Regulations vary across state lines. Neighboring Ohio has neither a mandatory reporting requirement nor driving suspension. In Maryland and New York, doctors are not required to report seizures, though both states impose 3- and 12-month driving suspensions, respectively.
There are exceptions to Pennsylvania's rule that can be made in collaboration with a patient's doctor. These exceptions include seizures that reliably occur during sleep or are consistently preceded by a warning sign, such as an aura or an upset stomach.
Peggy Beem Jelley is CEO of the Epilepsy Association of Western Pennsylvania. She echoed AAN's concern for the under-reporting of seizures when a long suspension looms.
"There is a lot of concern about whether or not these types of regulations actually prevent and discourage patients from being completely frank with their physicians," she said. "If you report that you've had a seizure, are you then going to lose your driver's license? If you lose your driver's license, are you then going to lose your job? Are you then going to lose your independence?"
Decisions like that could keep patients from the care they need. For that reason, she wants to get the word out about the new update.
"People are sort of slowly finding out," she said, "I think the thing that's most interesting is that it's patients who are educating physicians."
Her office has received multiple calls saying that patients, after suffering a breakthrough seizure, mention to their doctors that they'll be back in only three months for a follow-up evaluation, often surprising the physicians.
Ultimately, Beem Jelley sees this decrease as a sign of improved understanding of the condition.
She wants residents unfamiliar with epilepsy to know how common the condition is, noting that 1 in 26 will develop epilepsy and that it is a spectrum disease that is unique for each patient. Most importantly, she says it's critical to know that treatment has advanced to the point that many can live completely seizure-free. She said other drivers on the road should not be concerned, as all aspects of care are trending positively.
"Pittsburgh is lucky in that it has not one, but two Level 4 epilepsy centers," Beem Jelley said. She encourages patients experiencing medication-resistant symptoms to take advantage of the city's resources.
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