Monthly Case

A 27-year-old male patient suffered from first epileptic seizures 5 years ago. Seizures were characterized by loss of contact, staring, and swallowing, duration is 1 min. These automotor (= complex partial) seizures initially manifested in wakefulness and in sleep. The patient did not remember an aura preceding seizures from wakefulness, by nature he could not comment on potential auras in seizures from sleep. Two high-quality brain MRIs were normal. This patient suffers from cryptogenic partial epilepsy.

Antiepileptic drug treatment was initiated with lamotrigine, the patient has now been free of seizures from wakefulness with 500 mg daily. The patient’s partner still reports occurrence of 2-3 automotor seizures per year from sleep. The patient himself is amnesic for and thus not distracted by these seizures, he did not follow our recommendation for antiepileptic combination therapy.

The patient owns a driving license since his 18th birthday, he did not drive since his first seizure in the 22nd year of life. He now asks if he is allowed to drive, as for the last 4 years his seizures exclusively manifested in sleep.

We could approve his request. The German driving regulations (November 2009), which apply to most other countries, at first generally prohibit driving in people with epilepsy. But there are exeptions. The most prominent is seizure freedom for more than the last 12 months. In addition, people with seizures occurring exclusively during sleep for more than the last 3 years are allowed – despite continuing seizures – to drive a car themselves. It is presumed that – with unchanged antiepileptic drugs – seizures continue to occur exclusively in sleep and that manifestation from wakefulness is highly unlikely.

Cases of the months before