Broda Otto Barnes and Epilepsy and driving: Difference between pages

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Persons with [[epilepsy|seizure disorders]] may be putting the public at risk from their operation of a [[motor vehicle]]. It is for this reason that most people diagnosed with epilepsy are forbidden or restricted by their local laws from operating vehicles. However, there are usually exceptions for those who can prove that they have stabilized their condition. Those few whose seizures do not cause impairment of consciousness, whose seizures only arise from sleep, or who may be able to predict their seizures in order to ensure that they do not lose consciousness behind the wheel of a moving vehicle may be exempt from such restrictions, depending on local laws. There is an ongoing debate in [[bioethics]] over ''who'' should bear the burden of ensuring that an epilepsy patient does not drive a car or fly an airplane or spaceship.
'''Broda Otto Barnes''' ([[April 14]], [[1906]] &ndash; [[November 1]], [[1988]]) was an American physician who became an authority in the diagnosis and treatment of [[hypothyroidism]]. He spent more than 50 years of his life researching and treating [[endocrine dysfunction]]s, specializing in the [[thyroid gland]].<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=The Thyroid Gland: Cures, Fallacies and Fixes. |url=http://www.highbeam.com/doc/1G1-73959335.html |quote= Several decades ago, one of the dedicated thyroid experts, Broda Barnes, MD, was the first to advocate the administration of glandular thyroid extract ... |publisher=Townsend Letter for Doctors and Patients |date= |accessdate=2008-04-16 }}</ref><ref name="riddleillness">{{cite book |last=Langer |first=Stephan |authorlink= |coauthors= |title=Solved: The Riddle of Illness. |year=2000 |publisher=[[McGraw-Hill]] |quote=... A prime mover in clinical research on the thyroid gland for half a century, the late Broda O. Barnes, MD, Ph.D., was also a prime mover behind the writing of ... | url=http://books.google.com/books?id=v-8xz2eiAkMC&dq |isbn=0658002937 }}</ref>
<ref name="barnesfound">{{cite web |url=http://brodabarnes.org/who_we_are.htm |title=Broda O. Barnes |accessdate=2008-04-16 |quote=Broda O. Barnes, M.D., Ph.D. dedicated more than 50 years of his life to researching, teaching and treating thyroid and related endocrine dysfunctions in this country and abroad. |publisher=Broda O. Barnes MD Research Foundation, Inc. }}</ref>


==Laws in various places==
Barnes is credited for several important discoveries in the field of endocrinology pertaining to the thyroid gland. These include:
===United States===
In the [[United States of America|U.S.]], people with epilepsy can drive if their seizures are controlled with medication or other treatment and they meet the licensing requirements in their state. How long they have to be free of seizures varies in different states, but it is most likely to be between three months and a year.<ref name="EpilepsyFndtn-Driving">Epilepsy Foundation
[http://www.epilepsyfoundation.org/answerplace/Social/driving/drivingu.cfm Driving and You - Can you drive an automobile if you have epilepsy?].</ref><ref name="EpilepsyFndtn-StateLaws">Epilepsy Foundation [http://www.epilepsyfoundation.org/living/wellness/transportation/drivinglaws.cfm Driver Information by State]</ref> The majority of the 50 states place the burden on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. A minority of states place the burden of reporting on the patient's physician. After reporting is carried out, it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.


The Epilepsy Foundation's Jeanne A. Carpenter
 Epilepsy Legal Defense Fund is dedicated to advancing the rights of people with epilepsy by changing discriminatory practices, policies and laws and to ending epilepsy-related discrimination and injustice through education and increased access to legal services for individuals with epilepsy through a system of managed referrals and legal support to a nationwide network of attorneys committed to this cause.
* developing a simple diagnostic test for hypothyroidism.
* realizing the inadequacy of thyroid blood tests, contributing to a high prevalence of undiagnosed hypothyroidism.
* realizing the superiority of [[desiccated thyroid extract]] over synthetic drugs, in treating hypothyroidism.
* showing hypothyroidism is a cause of other chronic diseases including heart disease.


Additionally, the Epilepsy Foundation is a vigorous advocate for people with epilepsy. In the United States, the Foundation has been active in Congress, the executive branch, and the courts, focusing attention on the needs of those with epilepsy. Priorities for the Foundation include: the availability of affordable quality health care, the search for the cure, and the protection of civil rights for people with epilepsy.
Barnes' views were never widely adopted in mainstream medicine, yet they continue to be vigorously supported by some practitioners.<ref name="thyroidhealthy">{{cite book |last=Durrant-Peatfield |first=Barry |authorlink= |coauthors= |title=Your Thyroid and how to keep it healthy |year=2006 |publisher=Hamnmersmith Press | quote= |pages= | url=http://books.google.com/books?id=R2-FAAAACAAJ }}</ref> <ref name="hypotype2">{{cite book |last=Starr |first=Mark |authorlink= |coauthors= |title=Hypothyroidism Type 2 |year=2005 |publisher= |quote= |pages=174 | url=http://books.google.com/books?id=NbFzAAAACAAJ&dq |isbn=0975262408 }}</ref> <ref name="livingwell">{{cite book |last=Shomon |first=Mary |authorlink= |coauthors= |title=Living Well with Hypothyroidism: | year=2005 | publisher=Collins |quote= |pages=57 | url=http://books.google.com/books?id=AV_7ltX0WEAC }}</ref> <ref name="riddleillness"/>


===United Kingdom===
In the [[United Kingdom|UK]], it is the responsibility of the patients to inform the [[Driver and Vehicle Licensing Agency]] (DVLA) if they have epilepsy.<ref name ="UKEpilepsy-Driving">UK [[Epilepsy Action]]: Driving and Epilepsy, [http://www.epilepsy.org.uk/info/driving/seizure.html I've had a seizure. What should I do?]</ref> The DVLA rules are quite complex,<ref name="DVLA-Driving">UK Driver and Vehicle Licensing Agency [http://www.dvla.gov.uk/at_a_glance/content.htm Guide to the Current Medical Standards Of Fitness to Drive]. Full details for doctors regarding epilepsy are given in the [http://www.dvla.gov.uk/at_a_glance/ch1_neurological.htm#appendix Appendix]. Information for drivers can be found in [http://www.dvla.gov.uk/drivers/dmed1_files/group1.htm#nc Medical Rules - Group 1 Licence Holders]</ref> but in summary,<ref name="UKEpilepsyActionBooklet">UK Epilepsy Action: booklet with further details about driving [http://www.epilepsy.org.uk//download/file/78 PDF]</ref> those continuing to have seizures or who are within 6 months of medication change may have their licence revoked. A doctor who becomes aware that a patient with uncontrolled epilepsy is continuing to drive has, after reminding the patient of their responsibility, a duty to break [[confidentiality]] and inform the DVLA. The doctor should advise the patient of the disclosure and the reasons why their failure to notify the agency obliged the doctor to act.


===Sweden===
In [[Sweden]], a person must be seizure-free for five years before being allowed to drive professionally<ref name=autogenerated1>http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1176346</ref>.


===Australia===
== Diagnosis of Hypothyroidism==
[[Australia]] requires patients to be seizure-free for 3-6 months for recently-diagnosed seizures, and for two years for chronic epilepsy<ref name=autogenerated1 /><ref>http://www.epilepsyassociation.com.au/info/lifestyle/driving.html.</ref>.
[[Image:Basal_Temperature_Test.jpg|thumb|200px|right|Barnes Basal Temperature Test]]


===Japan===
Perhaps Barnes' most celebrated accomplishment was the invention of a diagnostic test for thyroid function, now known as the "Barnes Basal Temperature Test". This test is performed by placing a thermometer in the armpit for 10 minutes immediately upon waking. A measurement of 97.8F (36.6C) or below was considered by him to be highly indicative of hypothyroidism, especially when hypothyroid symptoms are present. A reading over 98.2F (36.8C) was indicative of hyperthyroidism. (Menstruating women must take this test on day 2-4 their cycle; When using a digital thermometer, the button must be pressed at the 10 minute mark)<ref name="unsuspectill">{{cite book |last=Barnes |first=Broda |authorlink= |coauthors= |title=Hypothyroidism: the Unsusptected Illness |year=1976 |publisher=HarperCollins |quote= |pages= | url=http://books.google.com/books?id=2sqMx5UdZbcC&dq=broda+barnes |isbn=069001029X }}</ref>
[[Japan]] has some of the world's strictest laws pertaining to epilepsy and driving, requiring all patients to be seizure-free for up to five years before being issued a license<ref name=autogenerated1 /><ref>[http://www.ncbi.nlm.nih.gov/pubmed/1762210 A study on driving status in 98 epileptic patients...[Jpn J Psychiatry Neurol. 1991&#93; - PubMed Result<!-- Bot generated title -->]</ref>.


==Flying==
While most places allow people with their seizures under control to drive a car, laws regarding the operation of an [[airplane]] generally are a lot stricter. In the United States, the [[Federal Aviation Administration]] often prohibits anyone with epilepsy from being issued a [[pilot's license]], even if the seizures are controlled by a medication or have completely ceased. The only epilepsy patients who may be issued a license are those who have had seizures during childhood, but have been seizure-free since, and have a normal [[electroencephalogram|EEG]]. Those with [[Rolandic seizure]]s may be allowed to fly if seizure-free for at least 4 years. Children who have suffered a [[febrile seizure]] prior to the age of 5 may fly if off of all seizure medication for at least three years. Regardless, all medical records must be submitted to the FAA<ref>[http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item46/amd/nc/ Aviation Medical Examiner<!-- Bot generated title -->]</ref>.


==Accidents caused by a seizure while driving==
The details of the test were published in the [[Journal of the American Medical Association]] (JAMA) in August of 1942 ("Basal Temperature vs. Basal Metabolism"), and again in [[The Lancet]] in 1945. <ref name="unsuspectill" /><ref name="thyroidhealthy"/> Though the test was not widely adopted by the medical professional as a whole, it was and continues to be enthusiastically endorsed by a minority of medical doctors and many alternative practitioners. <ref name="livingwell"/>
A study conducted by the [[National Center for Health Statistics]] found that fatalities caused by seizures that occurred while driving were relatively rare, resulting in less than 0.2% of all traffic-related fatalities in the years 1995-97<ref>[http://www.neurology.org/cgi/content/abstract/63/6/1002?ck=nck Mortality in epilepsy: Driving fatalities vs other causes of death in patients with epilepsy - Sheth et al. 63 (6): 1002 - Neurology<!-- Bot generated title -->]</ref>.


In March 2002, a [[Frederick, Maryland]] man was charged with [[vehicular manslaughter]] after a seizure he had while operating a motor vehicle resulted in an [[car accident|accident]] that killed 4 people<ref>[http://www.highbeam.com/doc/1P1-53142276.html Md. Driver Indicted in Deaths of Man, Sons; Epileptic Blamed Seizure for Crash | Article from The Washington Post | HighBeam Research<!-- Bot generated title -->]</ref>. The man had been using a nerve stimulating device to treat his epileptic condition rather than seeking medical treatment<ref>[http://www.highbeam.com/doc/1P1-51699063.html Driver in Frederick Crash That Killed 4 Has Epilepsy; Man Tried to Treat Himself Before Accident, Authorities Say | Article from The Washington Post | HighBeam Research<!-- Bot generated title -->]</ref>. He had been using this [[home remedy]] out of fear that if he had reported his condition to a physician, he would be stripped of his license.

Barnes didn't consider his Basal Temperature Test to be 100% conclusive, and acknowledged there were other causes of lowered basal temperature. Nevertheless, he maintained that it was the most useful diagnostic test in the diagnosis of hypothyroidism, superior even to all modern blood tests. Barnes considered modern blood tests--like the Basal Metabolism Test and the Protein Bound Iodine Test--to be unreliable, leaving many patients with clinical symptoms of hypothyroidism undiagnosed and untreated.<ref name="barnesfound"/> Barnes estimated in the 1980's, that the prevalence of undiagnosed hypothyroidism had risen to affect more than 50% of the American population.<ref name="barnesfound"/><ref name="unsuspectill"/>

== Treatment of Hypothyroidism==

Barnes treated hypothyroidism by prescribing patients a daily dose of thyroid hormone. He recommended starting with a small dose (1 grain for a healthy adult, 1/4 grain for children), then slowly increasing the dosage in monthly intervals until symptoms resolved. For most patients, he recommended continuing thyroid medication for life at that optimal dose, though some could be slowly weened off. He advised patients to take the thyroid medication first thing in the morning on an empty stomach, at least 20 minutes before food.

Barnes used [[desiccated thyroid extract]] almost exclusively, noting that patients experienced much better improvement of symptoms with the natural extract, rather than synthetic drugs. <ref name="barnesfound"/> He claimed that the even with synthetic combination drugs containing T4 and T3, patients were left with symptoms (dry skin & fluid retention), that upon switching to [[desiccated thyroid extract]] would resolve. This observation lead Barnes to speculate that there are additional undiscovered active components in the natural extract besides T4 and T3. Modern research has revealed that T2 (diidothyronine) and T1 (monoidothyronine) are also present, thought their function is still not fully understood.<ref name="hypotype2"/>

During his years of practice, Barnes also began to conclude that virtually all his hypothyroid patients had a concomitant [[adrenal insufficiency]]. Following this discovery, he routinely gave an accompanying physiological dose of adrenal steroid ([[Prednisone]] 5mg/day) together with desiccated thyroid extract. Barnes found this especially mandatory in patients showing more severe adrenal insufficiency exhibited by low [[systolic blood pressure]] (below 100). <ref name="unsuspectill"/><ref name="barnesfound"/>

==Heart Disease==

Barnes performed significant research into the cause of heart disease. During his lifetime he spent many summers in [[Graz]], Austria, reviewing and researching autopsy reports in the city hospital. The Graz autopsy records are widely considered to be the oldest and most complete in the world, and came as a result of the decree of empress [[Maria Theresa of Austria]] over 200 years ago, that autopsies are mandatory for all hospital deaths in the city of Graz. <ref name="unsuspectill" />

His study of over 70,000 of these autopsy reports spanning the war years of 1939-1945, lead Barnes to conclude that [[atherosclerosis]]--the underlying cause of [[heart disease]] and heart attacks-- was not caused by diet and [[cholesterol]] as is widely believed, but instead by hypothyroidism. <ref name="unsuspectill" />

The cholesterol theory of heart disease credits the drop in consumption of fatty foods during the war years for the drop in heart attacks, and the increase of heart attacks after the wars end with the resumed availability of fatty foods. <ref name="unsuspectill" />

Barnes’ autopsy research however, showed that in the war years when the rate of deaths from heart attacks dropped, the patients who were dying—largely due to [[Tuberculosis]]--had greatly accelerated rates of atherosclerosis. Barnes pointed out that the vast majority of patents who had died would have died from a heart attack soon after if the infection had not killed them first, and furthermore that the patients were largely hypothyroid.<ref name="unsuspectill" />

Barnes concluded then, that the hypothyroid patient is both susceptible to infection and atherosclerosis, and it is a question of circumstances that will determine which will be fatal first. Thus the drop and rebound of heart attacks during the and after the war years can be attributed to an increased rate of infectious disease during the war, and a sharp decrease after the war due to the availability of antibiotics.<ref name="unsuspectill" />

Barnes also conducted a multi-decade study of his own patients, that showed a 94% reduction in the rate of heart attacks as compared to the [[Framingham Heart Study]]. Barnes concluded that this was due to the thorough screening for and effective treatment of hypothyroidism among his patients, which largely prevented the development of atherosclerosis.<ref name="unsuspectill" />

==Cancer==

Barnes claimed there was a strong connection between the hypothyroidism and [[cancer]]. He often referred to research showing that [[tumor]] transfers in mice will not succeed, unless the thyroid of the receiving mouse is removed first. He also pointed out that given the thyroid's role in immunity, it should not be surprising that depressed thyroid function will depress the bodies ability to fight cancer.<ref name="unsuspectill" />

Barnes' autopsy research in Graz also informed his view on cancer, noticing that specific forms of cancer exploded after [[World War II]] with the introduction of [[antibiotics]]. In particular: [[prostate cancer]], [[lung cancer]] and cancer in children, all had over a 300% increase per 1000 deaths from 1930 to 1970--occurring mostly in the 25 year period after the war. Barnes concluded that these increases were due to the hypothyroid patient now living long enough to acquire the cancers, whereas previously they didn’t survive the [[infectious diseases]]. In the same way as heart attacks, the susceptibility to cancer and infections were concomitant, and the removal of one allowed the other to manifest.<ref name="hypotype2"/>

Barnes claimed that the cancer rate in his clinic was less than 50% below average, and certain forms of cancer such as [[lung cancer]], were totally absent. <ref name="unsuspectill" />

==Depression and Mental Illness==

Barnes emphasized that mental illnesses are associated with hypothyroidism, especially in the more severe forms. Barnes found that depression in general was a common symptom of hypothyroidism, and was often reversible with thyroid therapy. He also noted that season depression in the colder months was a clue to a thyroid component of depression, as the colder weather puts a higher demand on the thyroid to step up metabolism to keep the body warm. Barnes had concerns that there may be patients in mental institutions who are in fact hypothyroid, but improperly diagnosed.<ref name="unsuspectill" />

==Hypertension==

Barnes also noticed that a great number of patients with pre-existing [[hypertension]] would normalize after thyroid therapy. After reviewing his records, he estimated that thyroid therapy was effective in normalizing blood pressure in approximately 85% of his hypertension patients.

==Arthritis==

In Barnes' experience, virtually all patients with [[arthritis]] have hypothyroidism. Barnes claimed to have tremendous success in treating arthritis with thyroid therapy, particularly in combination with Predsnisone (5mg-10mg/day). This lead Barnes to conclude that the adrenal glands play an important role in the development of arthritis.<ref name="unsuspectill" /><ref name="barnesfound"/>

==Diabetes==

After many years of practice, Barnes also realized that though he had many [[diabetic]] patients, he had not seen virtually a single diabetic complication in his practice. This, along with his previous research into heart disease, lead Barnes to believe that 98% of diabetic patients have a concomitant hypothyroidism. And, when the hypothyroidism in diabetics is properly treated with desiccated thyroid extract, it prevents the atherosclerosis that leads to the various complications seen in diabetics.<ref name="unsuspectill" />

==Hypoglycemia==

Barnes discovered that 95% of his patients suffering from [[hypoglycemia]], would normalize after proper thyroid therapy. Barnes concluded that in hypothyroidism, the liver is sluggish and unable to meet the demands of converting [[glycogen]] to [[glucose]] when required, causing blood sugar to drop. By restoring the metabolism of the [[liver]] with adequate thyroid, it was then able to properly normalize blood sugar levels. <ref name="unsuspectill" /><ref name="barnesfound"/>

==Migraine and Other Headaches==

After treading a co-worker for hypothyroidism with desiccated thyroid extract, Dr. Barnes was pleasantly surprised when the co-workers' chronic [[migraine]] headaches resolved almost completely. This convinced Dr. Barnes that there was a connection between hypothyroidism and chronic severe [[headaches]] including migraines, and he proceeded to successfully treat many patients in the same manner over the years. Dr. Barnes claimed a success rate of 95% in treating patients suffering chronic headaches with thyroid therapy. He hypothesized that the swelling that often occurs in hypothyroidism likely elevated the pressure inside the head, leading to these headaches.
<ref name="unsuspectill" />

==Susceptibility to Infection==

Barnes noted that a common feature of Hypothyroidism is a general susceptibility to infection. All infections were more prominent including: sinus infections, respiratory infections, bladder infections etc. Barnes found that when patients hypothyroidism was corrected, their resistance was substantially raised and infections were far less common. Barnes claimed to use antibiotics only 1/10 as much as other physicians because of the proper treatment of hypothyroidism in his practice.<ref name="unsuspectill" />

==Menstrual Disorders and Infertility==

In Barnes experience, vitually all menstrual disorders were related to hypothyroidism, and would resolve under thyroid therapy. The early and late onset of menses also were highlighted by Barnes as symptoms of low thyroid function. Barnes claimed also a high rate of success of treating infertile couples with thyroid therapy. He claimed that most infertile women would become fertile under thyroid therapy, but a small fraction also required adrenal support, usually in the form of Prednisone (5mg/day).<ref name="unsuspectill" />

==Skin Disorders==

Barnes found that many skin disorders would resolve with thyroid therapy including: [[acne]], [[dry skin]], [[psoriasis]], [[excema]], skin itching & scaly skin. Barnes noted that skin circulation was reduced to as much as 1/4 to 1/5 of normal in advanced hypothyroidism. With this lowered circulation, there is a lowered nourishment and a lowered removal of waste products, leading to lowered resistance and a wide variety of skin diseases.<ref name="unsuspectill" />

==Pregnancy testing==
The [[bitterling]] was shown to respond to hormones in a pregnant woman's urine, but the work was later discredited. <ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Deceptive Bitterling |url=http://www.time.com/time/magazine/article/0,9171,848651,00.html |quote=Not quite two years ago physicians and prospective parents welcomed the news that a small, carp-like fish could tell whether or not a woman was going to have a baby ... The bitterling lost her standing and the doe rabbit and mouse were reinstated as nature's best indicators of human pregnancy. But Obstetricians Kanter and Klawans pursued the matter with another research mate, Physiologist Broda Otto Barnes, secured further results which they detailed in Science last week. |publisher=[[Time (magazine)]] |date=[[October 12]], [[1936]] |accessdate=2008-04-16 }}</ref><ref>{{cite journal | quotes = | last = | first = | authorlink = | coauthors = | date = | year =1936 | month = | title =Bitterling Ovipositor Lengthening Produced By Adrenal Extracts | journal =[[Science (journal)|Science]] | volume = | issue = | pages = | publisher =[[AAAS]] | location = | issn = | pmid = | doi = | bibcode = | oclc = | id = | url =http://www.sciencemag.org/cgi/content/citation/84/2179/310-a | language = | format = | accessdate = | laysummary = | laysource = | laydate = | quote = }}</ref>

==Legacy==
In his last years, Dr. Barnes established a not-for-profit foundation to continue the legacy of his research: Broda O. Barnes Resarch MD, Research Foundation, Inc. <ref name="barnesfound"/>.

==Publicatons==
*{{cite book |last=Barnes |first=Broda Otto |authorlink= |coauthors= |title=Hypothyroidism: The Unsuspected Illness |year=1976 |publisher=[[HarperCollins]] |quote=And they discuss whether you too may be hypothyroid, affected by a condition even a physician may not recognize. Included is a simple test you can make at home to discover if hypothyroidism may be the real, previously unsuspected cause of your ill health. | url=http://books.google.com/books?id=2sqMx5UdZbcC&dq |isbn=069001029X }}

*{{cite book |last=Barnes |first=Broda Otto |authorlink= |coauthors= |title=Hope for Hypoglycemia: It's not your mind, it's your liver |year=1989 |publisher=Fries Communications |quote= | url=http://books.google.com/books?id=PHKeAAAACAAJ |isbn=0913730262 }}

*{{cite book |last=Barnes |first=Broda Otto |authorlink= |coauthors=Charlotte W. Barnes |title=Solved: The Riddle of Heart Attacks |year=1976 |publisher=Robinson Press |quote= | url=http://books.google.com/books?id=uA1LAAAACAAJ |isbn=0913730270 }}

*{{cite book |last=Barnes |first=Broda Otto |authorlink= |coauthors=Charlotte W. Barnes |title=Heart Attack Rareness in Thyroid-treated Patients |year=1972 |publisher=|quote= | url=http://books.google.com/books?id=fII5AAAACAAJ |isbn=0398025193 }}


==External links==
==External links==
*[http://www.brodabarnes.org/ Official website]

==Books Endorsing Dr. Barnes==
Recent books endorsing Dr. Barnes philosophy on diagnosing and treating hypothyroidism:

*{{cite book |last=Starr|first=Mark |authorlink= |coauthors= |title=Hypothyroidism Type 2, the Epidemic |year=2005 |publisher=New Voice |quote= | url=http://books.google.com/books?id=NbFzAAAACAAJ&dq |isbn=0975262408 }}

*{{cite book |last=Langer|first=Stephan |authorlink= |coauthors= |title=Solved: The Riddle of Illness |year=2006 |publisher=McGraw-Hill |quote= | url=http://books.google.com/books?id=v-8xz2eiAkMC |isbn=0658002937}}

*{{cite book |last=Brownstein|first=David |authorlink= |coauthors= |title=Overcoming Thyroid Disorders |year=2002 |publisher=Medical Alternatives Press |quote= | url=http://books.google.com/books?id=5ejBAAAACAAJ |isbn=0966088220}}

*{{cite book |last=Durrant-Peatfield|first=Barry |authorlink= |coauthors= |title=Your Thyroid and How to Keep It Healthy |year=2006 | publisher=Hammersmith Press Limited |quote= | url=http://books.google.com/books?id=R2-FAAAACAAJ |isbn=190514010X}}


*[http://www.epilepsy.com/epilepsy/social_driving Epilepsy driving rights in the United States page 1] [http://www.epilepsy.com/epilepsy/rights_driving Epilepsy driving rights in the United States page 2]
==Doctors Supportive of Dr. Barnes Philosophy==


*[http://www.drdach.com/ Dr. Jeffery Dach, M.D.]
*[http://www.21centurymed.com/ Dr. Mark Starr, M.D.]
*[http://www.drbrownstein.com/ Dr. David Brownstein, M.D.]
*[http://www.mbschachter.com/ Dr. Michael Schachter, M.D.]
* Dr. Stephan Langer, M.D.


==References==
==References==
{{Reflist}}
{{reflist}}


[[Category:American medical researchers|Barnes, Broda O.]]
[[Category:Epilepsy]]
[[Category:Traffic law]]
[[Category:Driving]]

Revision as of 15:28, 10 October 2008

Persons with seizure disorders may be putting the public at risk from their operation of a motor vehicle. It is for this reason that most people diagnosed with epilepsy are forbidden or restricted by their local laws from operating vehicles. However, there are usually exceptions for those who can prove that they have stabilized their condition. Those few whose seizures do not cause impairment of consciousness, whose seizures only arise from sleep, or who may be able to predict their seizures in order to ensure that they do not lose consciousness behind the wheel of a moving vehicle may be exempt from such restrictions, depending on local laws. There is an ongoing debate in bioethics over who should bear the burden of ensuring that an epilepsy patient does not drive a car or fly an airplane or spaceship.

Laws in various places

United States

In the U.S., people with epilepsy can drive if their seizures are controlled with medication or other treatment and they meet the licensing requirements in their state. How long they have to be free of seizures varies in different states, but it is most likely to be between three months and a year.[1][2] The majority of the 50 states place the burden on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. A minority of states place the burden of reporting on the patient's physician. After reporting is carried out, it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.

The Epilepsy Foundation's Jeanne A. Carpenter
 Epilepsy Legal Defense Fund is dedicated to advancing the rights of people with epilepsy by changing discriminatory practices, policies and laws and to ending epilepsy-related discrimination and injustice through education and increased access to legal services for individuals with epilepsy through a system of managed referrals and legal support to a nationwide network of attorneys committed to this cause.

Additionally, the Epilepsy Foundation is a vigorous advocate for people with epilepsy. In the United States, the Foundation has been active in Congress, the executive branch, and the courts, focusing attention on the needs of those with epilepsy. Priorities for the Foundation include: the availability of affordable quality health care, the search for the cure, and the protection of civil rights for people with epilepsy.

United Kingdom

In the UK, it is the responsibility of the patients to inform the Driver and Vehicle Licensing Agency (DVLA) if they have epilepsy.[3] The DVLA rules are quite complex,[4] but in summary,[5] those continuing to have seizures or who are within 6 months of medication change may have their licence revoked. A doctor who becomes aware that a patient with uncontrolled epilepsy is continuing to drive has, after reminding the patient of their responsibility, a duty to break confidentiality and inform the DVLA. The doctor should advise the patient of the disclosure and the reasons why their failure to notify the agency obliged the doctor to act.

Sweden

In Sweden, a person must be seizure-free for five years before being allowed to drive professionally[6].

Australia

Australia requires patients to be seizure-free for 3-6 months for recently-diagnosed seizures, and for two years for chronic epilepsy[6][7].

Japan

Japan has some of the world's strictest laws pertaining to epilepsy and driving, requiring all patients to be seizure-free for up to five years before being issued a license[6][8].

Flying

While most places allow people with their seizures under control to drive a car, laws regarding the operation of an airplane generally are a lot stricter. In the United States, the Federal Aviation Administration often prohibits anyone with epilepsy from being issued a pilot's license, even if the seizures are controlled by a medication or have completely ceased. The only epilepsy patients who may be issued a license are those who have had seizures during childhood, but have been seizure-free since, and have a normal EEG. Those with Rolandic seizures may be allowed to fly if seizure-free for at least 4 years. Children who have suffered a febrile seizure prior to the age of 5 may fly if off of all seizure medication for at least three years. Regardless, all medical records must be submitted to the FAA[9].

Accidents caused by a seizure while driving

A study conducted by the National Center for Health Statistics found that fatalities caused by seizures that occurred while driving were relatively rare, resulting in less than 0.2% of all traffic-related fatalities in the years 1995-97[10].

In March 2002, a Frederick, Maryland man was charged with vehicular manslaughter after a seizure he had while operating a motor vehicle resulted in an accident that killed 4 people[11]. The man had been using a nerve stimulating device to treat his epileptic condition rather than seeking medical treatment[12]. He had been using this home remedy out of fear that if he had reported his condition to a physician, he would be stripped of his license.

External links


References

  1. ^ Epilepsy Foundation Driving and You - Can you drive an automobile if you have epilepsy?.
  2. ^ Epilepsy Foundation Driver Information by State
  3. ^ UK Epilepsy Action: Driving and Epilepsy, I've had a seizure. What should I do?
  4. ^ UK Driver and Vehicle Licensing Agency Guide to the Current Medical Standards Of Fitness to Drive. Full details for doctors regarding epilepsy are given in the Appendix. Information for drivers can be found in Medical Rules - Group 1 Licence Holders
  5. ^ UK Epilepsy Action: booklet with further details about driving PDF
  6. ^ a b c http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1176346
  7. ^ http://www.epilepsyassociation.com.au/info/lifestyle/driving.html.
  8. ^ A study on driving status in 98 epileptic patients...[Jpn J Psychiatry Neurol. 1991] - PubMed Result
  9. ^ Aviation Medical Examiner
  10. ^ Mortality in epilepsy: Driving fatalities vs other causes of death in patients with epilepsy - Sheth et al. 63 (6): 1002 - Neurology
  11. ^ Md. Driver Indicted in Deaths of Man, Sons; Epileptic Blamed Seizure for Crash | Article from The Washington Post | HighBeam Research
  12. ^ Driver in Frederick Crash That Killed 4 Has Epilepsy; Man Tried to Treat Himself Before Accident, Authorities Say | Article from The Washington Post | HighBeam Research
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