Should patients with psychogenic nonepileptic seizures be allowed to drive?

Purpose: To investigate the risk of driving accidents in patients with psychogenic nonepileptic seizures. Methods: First, a survey was conducted in 82 physician-members of the American Epilepsy Society to determine what they recommend in patients with psychogenic seizures in regard to driving privileges. Second, we studied a population of 20 patients with proven psychogenic nonepileptic seizures diagnosed by prolonged EEG-video monitoring. We obtained the patients' driving records from the Wisconsin Department of Transportation. We used 1991 Wisconsin crash data as the reference year. We compared the expected number of motor vehicle crashes with the observed number of crashes. chi(2) With Yates' correction for continuity was used to test for statistical significance. Results: Of the 82 physicians questioned, 37 (45%) responded. Among respondents, the distribution was as follows: 49% applied the same restrictions as for patients with epilepsy; 32% did not place patients under any restrictions; and 19% decided on a case-by-case basis. The total number of reported crashes in the sample was eight, with no fatal crashes. This was not statistically significant (corrected chi(2), 0.53) compared with the expected number of motor vehicle crashes for the sample. Conclusions: This small series does not support the use of driving restrictions for patients with psychogenic nonepileptic seizures.