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Study: Mandatory Reporting of Seizures Backfires

Most patients say they'd stop driving on own if seizure occurred

WEDNESDAY, April 2, 2003 (HealthDayNews) -- When physicians are required by law to report their patients' loss of consciousness to the state, it takes a negative toll on the physician-patient relationship, a new study finds.

It's also more likely that patients who've had a seizure will conceal the information from their doctor, fearful of losing their driving privileges, says study author Dr. Kamala M. Rodrigues, a neurologist who will present her findings April 3 at the American Academy of Neurology's annual meeting in Honolulu.

Rodrigues conducted the study while a neurology fellow at Stanford University, polling 403 patients at the university's epilepsy clinic and retrieving 207 completed surveys.

For years, physicians have been concerned that mandatory reporting of loss of consciousness to local health officers or other authorities, now the law in six states, will negatively impact their relationship with their patients, Rodrigues says: "This is one of the first studies to show that patients share the same concern."

Seizures occur when a group of brain cells that normally discharge in a random fashion suddenly discharge together in a rhythmic burst, according to the Epilepsy Foundation. When seizures reoccur, epilepsy is diagnosed. Epilepsy affects about 2.3 million Americans, the foundation estimates. Medication to control the seizures is the most common treatment.

In Rodrigues' study, 8.6 percent of those who answered questions on concealment of seizure information said they had concealed such information and 19 percent had considered withholding such information. Thirteen percent said the mandatory reporting requirement adversely affected their relationship with their doctors.

Most striking was the finding that four of five patients said they would stop driving if they had a seizure, regardless of whether a mandatory reporting law was in place. In California, such reports to local health officials are then turned over to the Department of Motor Vehicles.

"I think that the bottom line of the study is that the mandatory reporting law has probably had some unintended consequences, and that it may be counterproductive to the intent of the law," Rodrigues says.

Besides California, states with mandatory reporting laws, Rodrigues says, include Oregon, Nevada, Delaware, New Jersey and Pennsylvania.

Once the loss of consciousness is reported, a patient's driver's license can be suspended for medical reasons. The seizure-free intervals required before license reinstatement, Rodrigues says, vary from three months to about 18 months.

The new study "confirms what we have suspected," says Alexandra Finucane, vice president for legal and governmental affairs for the Epilepsy Foundation. "The foundation has opposed mandatory reporting since 1974."

And, she adds, as the study suggests, "people can be trusted to self-regulate." It's also unfair, she adds, to single out epilepsy when so many other medical conditions -- including heart disease and diabetes -- can adversely affect driving ability.

"If you eliminate mandatory reporting, you eliminate the barrier to good medical care" that can occur when such a law makes patients think twice about telling their doctors about seizure problems, she says.

"We encourage people to not drive when they are having [problems with] seizures or when they are changing medications," Finucane says.

"The more you can put the patient in the driver's seat, no pun intended, the better," agrees Dr. Mark Spitz, a neurologist and epilepsy specialist at the University of Colorado in Denver.

In 18 years of caring for patients with epilepsy, he says, he is not aware of any auto accidents occurring due to a seizure. Mandatory reporting, he agrees, takes a toll on the doctor-patient relationship.

More information

Read the Epilepsy Foundation's stand on mandatory reporting. The group also has a page explaining seizure types.

SOURCES: Kamala M. Rodrigues, M.D., neurologist, Ann Arbor, Mich.; Alexandra Finucane, vice president, legal and government affairs, Epilepsy Foundation, Landover, Md.; Mark Spitz, M.D., director, University of Colorado Epilepsy Center, Denver; April 3, 2003, presentation, American Academy of Neurology annual meeting, Honolulu
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