“Epileptics as drivers”– the first report on motor vehicle accidents due to epileptic seizures in 1906

AbstractObjective The 1906 report of Franz Thalwitzer on motor vehicle accidents (MVAs) in two people with epilepsy has been frequently cited as the first report to provide justification for legal regulations to prohibit people with epilepsy from driving. Methods On the occasion of the 120th anniversary of the Thalwitzer report, we analyzed the clinical findings and the circumstances of the accidents outlined in the text to clarify whether the events described were definitive epileptic seizures. Results Both people had a history of epilepsy. Case 1, who drove a car, had been treated with bromides. Although clinical descriptions of the event leading to the car accident in case 1 are missing, the "car crash semiology" included several features reported as being significantly associated with seizure-related MVAs: one vehicle involved, a single person in the car, a single person in the entire crash, an initial "out of control movement" and probably veering from path on a straight road. In case 2, who drove a motorcycle, the event leading to the MVA was unwitnessed, but when found soon after the incident clinical features of a post-ictal state were evident followed shortly later by a bilateral convulsive seizure witnessed by a physician. Conclusion We were able to determine that the two incidents described 120 years ago were MVAs most likely caused by epileptic seizures. The demand for a driving ban for people with epilepsy seems justifiable at the beginning of the last century, given the almost complete lack of therapeutic options in 1906.