Problems faced by epileptic patients

Physicians treating patients with epilepsy are in a difficult legal situation when they have to assess their patients' ability to drive. In the current edition of the Deutsches -rzteblatt International (Dtsch Arztebl Int 2010; 107[13]: 217-23), the occupational physician Monika Gube and her coauthors describe the problems, using an individual case as an example.

Up to 800 000 patients in Germany suffer from manifest epilepsy and about five times as many people suffer an epileptic seizure once in their lives. Although the accident rate is not statistically higher for epileptics than for the average population, the physician has to decide between medical confidentiality and the risk of a traffic accident. There is no general obligation to notify the authorities, although the physician has the right to notify them if the patient is lacking in insight and wishes to continue to drive.

In the specific case, the 50-year old excavator operator had kept quiet about his epilepsy, as he was scared of losing his job. His driving presented a considerable risk, both to himself and to others, so that his driving license had to be withdrawn. If a physician fails to notify the authorities of a planned criminal act, this may have legal consequences for him, unless he makes a serious effort to prevent this act. As a consequence, the excavator operator lost his job. He now lives from an incapacity pension and suffers enormously from the loss of flexibility and social status. The authors point out that there might have been other solutions if the problem had been discussed earlier.