Driving impairment caused by episodic brain dysfunction. Restrictions for epilepsy and syncope.

The potential loss of driving privileges is a major concern of patients with epilepsy and other episodic brain illness. The extreme variation from state to state in reporting requirements and the duration of restrictions illustrate the legal ramifications of uncertain medical advice. We studied the reliability of various methods of predicting recurrences, including electroencephalograms, familial data, and epidemiologic data and concluded that we should offer more flexible, detailed guidelines. These ought to encourage regulators, colleagues, and patients and would perhaps increase highway safety through better compliance. Episodic changes in cognition unrelated to epilepsy or syncope remain a quagmire. When the most reliable risk factors are listed in tabular form, the result appears complex, but such a guideline should be fairer, easier to administer, and often more lenient than the present simplistic, arbitrary codes found in most states.