In 6 of those 13 states physicians could be held legally liable for their decisions regarding their epileptic patients driving capabilities. In many states, patients can also be legally liable for accidents, injury, damage and death caused by seizure related accidents. One of the major arguments in favor of restricting the licensing of epileptic drivers is the concern for public safety. However, the Johns Hopkins study showed that in a particular 2 year timeframe only 0.2% of fatal crashes occurred as a result of seizures. Alcohol related crash fatalities caused 156 times more driver deaths than seizure related crashes and young drivers between the ages of 16 and 24 were 123 times more likely to die in a fatal crash caused by their inexperience than an epileptic driver was to die in a crash that resulted from a seizure. Frontal lobe epileptic seizures unlike other epileptic seizures create symptoms that are as dangerous as loss of consciousness and much more difficult to discern from other problems such as substance use disorders, psychiatric disorders and disobedience. Jerking movements/lack of motor control, pedaling, pelvic thrusting, lapses in cognitive functioning and other hallmark symptoms of frontal lobe epileptic seizures all create dangerous behavior behind the wheel.
Neuromodulation
Vagus nerve stimulation (VNS):The last surgical procedure that can be done to help prevent the reoccurrence of seizures in the frontal lobes is to implant a stimulator on the vagus nerve. This device is a self-activating device that is inserted directly under the skin and can be controlled directly by the patient. When a patient is feeling the onset of an aura, he/she can activate the stimulator which in turn will provide stimulation to the left vagus nerve (the left vagus nerve is used because the right nerve plays a role in cardiac function). Although little is understood about the exact mechanism for vagal nerve stimulation, it has been proven to be a successful treatment that can often terminate seizures before they begin. It has the potential of being helpful in patients with resistance to AEDs.This procedure named Deep brain stimulation (DBS) another novel procedure that can be used utilizes a mechanism similar to that of a cardiac pacemaker The electrode is implanted into the patients brain, while a neuro-stimulator machine is placed beneath the skin of the chest. The stimulator sends an indication to the electrode in the brain to prevent any signal that potentially triggers or can trigger a seizure.Surgeries have been used as a treatment for FLE, however, meta-analyses have shown that proper etiological studies are important to give best postoperative results, with children <3 years of age showing pathology and location of the surgery as important factors.