Background Seizures in the past year affect approximately 20% of patients with epilepsy. Vehicle crashes are also well associated with epilepsy. Different requirements for drivers with epilepsy exist across state, regional and national jurisdictions. However, a widely accepted threshold for risk of crash of 1% is common in safety sensitive positions.
Objectives To develop evidence based guidelines for the treatment and return to work/driving for those with a history of seizures and epilepsy.
Methods A panel of 5 experts developed a set of specific questions regarding the prevalence of seizures and risks of recurrence. A research team developed a search strategy which included utilisation of specific search terms for each question. A systematic literature review was performed. Databases searched included Pubmed, EBSCO and Google Scholar.
Results 246 research articles were reviewed. For individuals with a history of a single, unprovoked seizure, evidence supports a minimum of 82.02 months (6.8 years) off anti-seizure medication and seizure free. A worker with a history of seizures should have a minimum of 10 years off anti-seizure medications and seizure free prior to returning to a safety sensitive position.
Discussion These analyses provide guidance for the treatment of seizures and epilepsy and return to safety sensitive positions. Implications The breadth of safety sensitive jobs includes fork lifting driving, truck drivers, bus drivers, overhead crane operations, and the airline industry.
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