Driving versus seizures

While shopping with her daughter last summer at a drugstore in Chicago, Stefanie London abruptly experienced blurred vision."The next thing I knew, I woke up at the emergency room," said London, a lawyer from Clayton who had suffered a seizure similar to the spells that afflict people with epilepsy.

Doctors quickly discovered a benign tumor in the lining of her brain.Because she had been rendered completely unconscious, it was half a year before London could legally get behind the wheel of her car, even though she had surgery to remove the tumor within a month of her seizure and never had another problem.

Strict prohibitions, such as a mandatory six-month freeze on driving that Missouri puts on people who've lost consciousness, have helped make traffic deaths because of epilepsy extremely rare.

In Illinois, the restrictions are not so clear cut, although drivers who lose consciousness behind the wheel immediately lose their licenses.But even these tight restrictions can't prevent fatalities.On Monday, Lisa Domer of Mascoutah and her 2-year-old son, Dagan, were killed when her car rolled into a pond in O'Fallon, Ill.

Authorities believe that Domer, who had epilepsy, suffered a seizure and was unaware that her car was idling toward the pond.Domer had told relatives and co-workers that with medication she had been seizure-free for two or three years. But she complained to friends that a new medication unrelated to epilepsy had made her feel "dizzy."

Epilepsy can cause a total blackout and convulsions, although more commonly, people may remain standing still during a seizure."They lose consciousness, they lose contact with the world," said Dr. James Willmore, professor of neurology at St. Louis University School of Medicine. "It may last between one and five minutes."According to a study provided by the Epilepsy Foundation, epileptic seizures cause about 90 traffic deaths each year in the United States.

That's less than one percent of the approximately 42,000 traffic deaths each year. In comparison, alcohol leads to about 13,000 of those deaths.Still, states feel it's important to ensure that drivers who may lose consciousness aren't behind the wheel when it happens.States' restrictions"Anyone with a medical condition that would impair their ability to drive has 10 days to notify us," said Beth Kaufman, a spokeswoman for the Illinois secretary of state.

Doctors are also supposed to notify authorities but aren't bound by the same 10-day timeline, she said.A medical board then reviews the driver's case, unless a doctor says the medical condition has been under control for at least six months. If someone passes out behind the wheel, his or her license is revoked until the board decides to reissue it, Kaufman said.

The board evaluates about 43,000 cases each year and may restrict licenses or decide to reinstate them.Kaufman confirmed that Domer had a valid Illinois drivers license.In Missouri, drivers aren't required to report at all. Doctors inform people who have lost consciousness because of a seizure that they can't drive until they've been seizure-free for six months.

Some states go further, requiring doctors to report their patients' seizures to appropriate authorities, said Willmore.At any given time, about 2 percent of the population - or about 6 million people - has epilepsy, he said. Epileptic seizures are caused by a rhythmic pulsing of electrical activity in the brain that shuts down consciousness.

The pulsing occurs from an imbalance in the brain between substances that stimulate and those that inhibit brain activity.Willmore compared the imbalance to a gymnast walking on a balance beam - too much energy can throw a person off, as can too little.Epilepsy may be inherent or the result of brain trauma, Willmore said. More than half of people with the disorder can control it using drugs, and many others get relief through surgery, he said.Help from friendsAlthough Domer made statements about her new medication less than a week before her death, medical authorities won't speculate on her case, including what might have triggered the seizure.

But authorities say that drug interactions are concerns for epileptics and for others."Something taken alongside epilepsy drugs could affect the drug's ability to control seizures," said Kimberli Meadows, spokeswoman for the Epilepsy Foundation, based in Landover, Md.The loss of driving privileges for those who've had a seizure can be eased by aid from friends and family, said London, the lawyer from Clayton.

While she was barred from driving, her husband took her to work and added additional driving duties to accommodate their three children, and she got rides from friends whenever possible, she said. London, 51, a long-distance runner and cyclist, often walked the three miles from her office to her home at night.

Once she started driving again, she stayed off the highways for an additional six months in fear of a recurrence, she said."People need to be aware that they need family support in a case like this," she said. "They can't be afraid to share it if they're having a problem."