Epilepsy in driver truck drama? ‘Illness has many manifestations’

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The drama in Nieuw-Beijerland in which a truck driver crashed into a group of residents at a barbecue, according to the suspect’s lawyer, happened because the driver had an epileptic seizure. RTL Nieuws spoke to a neurologist and a patient about this condition. “I don’t drive because I don’t want to be a danger to others.”

Epilepsy takes many forms, says neurologist Marian Majoie, professor of epilepsy at Maastricht University and the Kempenhaeghe Academic Center for Epileptology. “An epileptic seizure can consist of something as subtle as tingling in one hand until it is absent, but people can also suddenly fall because the whole body stiffens. Then the body starts to shake.”

Automatic pilot

Last night, the lawyer of the Spanish suspect of the truck drama in Nieuw-Beijerland told the talk show table at Jinek that the driver may have had an epileptic seizure behind the wheel. Majoie cannot make any statements about the credibility of that statement. “I can only explain the condition, not this particular case.”

The body can stiffen during a seizure, she explains, which could make you step on the gas. “It also happens that people have a reduced consciousness. Then someone can perform physical actions, more or less on autopilot, where someone is no longer able to perceive and react to his environment.”

Driving with epilepsy: what are the rules?

Whether or not you are allowed to drive with a medical condition is laid down in the Suitability Requirements Regulation 2000. The CBR has a page on its site specifically about epilepsy.

The passage most relevant to the truck drama in Nieuw-Beijerland is this:

“If your patient has a full driver’s license, stricter rules apply. If someone is taking seizure medication, he or she is not allowed to drive a truck or bus. This also applies if your patient has not had a seizure for a long time.”

Since the driver’s lawyer indicated last night in Jinek that the driver is indeed taking medication for his epilepsy, that would automatically mean that he has broken the law.

(More on this later in the gray box)

The response depends on which part of the brain the seizure occurs in, she says. “The brain is a complex whole. A kind of computer in which all kinds of software run at the same time. Sometimes the balance gets out of balance and a certain part of the brain, or the brain as a whole, becomes overstimulated.”

When that happens, “a discharge can take place in a group of brain cells,” says the neurologist. Depending on the group, this leads to different reactions. “If it happens locally in the brain, the seizure manifestations can be relatively mild such as tingling, numbness, or isolated jerks in part of an arm, leg or face.”

Dropped head against the counter

“When the entire brain discharges, the patient loses consciousness and shocks can occur throughout the body. We call this a tonic-clonic seizure.”

Mariska Osterop (40) from the Gelderland village of Spankeren knows from experience what that is, such a tonic-clonic attack. “When I was eight, I fell with my head against the counter. That’s how it started. In the first few years I just fell over several times a day. Then I quickly got up again.”

Then she was “always there,” she says, but there was nothing she could do to stop it. “I could always remember everything, but you can’t even reach out your hands to protect yourself. You can only hope you end up right.”

Mariska Osterop.

Mariska Osterop.

From the age of 12, the heavier, tonic-clonic seizures started, Mariska says. “For many years I have had two types of seizures. Often these are focal seizures. My body suddenly goes completely silent. So when I’m walking, I suddenly stop. I can’t say anything. When I have something in my hands , I drop that. I hear and see everything, I don’t fall over myself, but I can’t do anything.”

She often ‘shoots’ out again, after about thirty seconds. However, sometimes it turns into a severe tonic-clonic seizure. “It can take up to four minutes.”

‘Don’t want to be a danger to others’

Her children, aged 9 and 10, know what to do: if it can keep their mother from getting hurt in the fall, put something under her head, and get help if needed.

There was a period of a few years when she was symptom-free. “In theory I was allowed to drive a car. But I deliberately didn’t do that because it can always come back. I don’t drive, because I don’t want to be a danger to others.”

Now she has been ‘implanted’ with a system called Deep Brain Stimulation, which uses a pacemaker and two wires to the brain to send electrical shocks throughout the day to the areas where the epilepsy is at the source. And that helps a lot: “Before I got this, I had 3 or 4 attacks a week. Now it’s quarterly.”

Professor Majoie says the same applies to the memory after an attack as to the intensity: “Sometimes people remember everything, sometimes nothing.”

But there is also a similarity, she says: attacks always happen suddenly. “Most people only feel it coming a few seconds in advance. Sometimes a little longer, for example a minute. But it does take you by surprise and it is often not possible to anticipate it.”

Medication

Epilepsy can be treated with medications. People who were treated with medicines for their epilepsy as children sometimes need to take these medicines for a long time to remain seizure-free. However, that is not always necessary. “If people have been seizure-free for years, the aim is to gradually taper off the medication, but that taper does not always work,” says the neurologist.

Epilepsy can develop at any age. The highest ‘frequency of onset’ is either under 10 years of age or older, above 60 years of age. In the latter group, a first attack is often the result of brain damage, for example due to a blood flow disorder in the brain or a tumor. “And sometimes a cause cannot be identified.”

It cannot be ruled out that someone who suffered from seizures as a child and then did not for years will suddenly be attacked again by attacks, says Majoie. “And the causes can be many.”

Traffic and Epilepsy Rules:

Car and motorcycle license

  • First time epileptic seizure: no driving for 6 months.
  • More frequent seizures: Not driving for 12 months after last seizure.
  • The patient reduces medication and has an epileptic seizure: do not drive for at least 3 months.

Depending on the type of attack, the period when someone is not allowed to drive may be different.

Large driver’s license: stricter rules

  • After the first epileptic seizure: do not drive for 5 years. Possible test by CBS after 2 years.
  • More frequent epileptic seizures: not driving for 10 years. Possibly after 5 years of research by CBR.

Medicines

The drugs phenobarbital, phenytoin, carbamazepine (more than 600 milligrams per day) and primidone should not be used in the first year of taking these drugs. You are not allowed to practice professions that involve passengers, such as a taxi driver or driving instructor.

You can read more about this at rijveiligmetmedijnen.nl.

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