Seizure Disorder and Medical Certification of Commercial Motor Vehicle Driver Safety Evidence Report and Systematic Review Prepared for the Federal Motor Carrier Safety Administration Contract: DTMC75-13-R-00025 March 2019 Authors: Katherine Fiedler, Ph.D. Claire Cropper Joanne Liem Chris Cotterman Daniel Paoletti Table of Contents Executive Summary ...............................................................................................................................4 Introduction .........................................................................................................................................4 Research Questions ............................................................................................................................5 Search Methodology ..........................................................................................................................5 Findings ...............................................................................................................................................6 Research Question 1 .......................................................................................................................6 Research Question 2 .......................................................................................................................6 Research Question 3 .......................................................................................................................7 Research Question 4 .......................................................................................................................7 Research Question 5 .......................................................................................................................7 Research Question 6 .......................................................................................................................7 Preface ......................................................................................................................................................9 Introduction .........................................................................................................................................9 Purpose of Report .............................................................................................................................11 Report Organization ........................................................................................................................12 Report Funding and Role of Funders ............................................................................................12 Background ...........................................................................................................................................13 What is Epilepsy? .............................................................................................................................13 What is a Seizure? .............................................................................................................................14 Seizure Triggers ................................................................................................................................15 Epilepsy Treatment ..........................................................................................................................16 Research Methodology and Evidence Base ......................................................................................17 Sources Searched ..............................................................................................................................17 Search Terms Used ...........................................................................................................................18 Table 1: Keywords ........................................................................................................................18 Table 2: Search Terms Used ........................................................................................................20 Inclusion/Exclusion Criteria ...........................................................................................................22 Evidence Summary ..............................................................................................................................25 Research Question 1 .........................................................................................................................26 Evidence Base ................................................................................................................................26 Summaries of Included Studies ..................................................................................................27 Quality of Included Studies ........................................................................................................30 Findings ..........................................................................................................................................31 Research Question 2 .........................................................................................................................34 Evidence Base ................................................................................................................................34 Summaries of Included Studies ..................................................................................................35 Quality of Included Studies ........................................................................................................50 2 Findings ..........................................................................................................................................53 Research Question 3 .........................................................................................................................57 Evidence Base ................................................................................................................................57 Research Question 4 .........................................................................................................................58 Evidence Base ................................................................................................................................58 Summaries of Included Studies ..................................................................................................59 Quality of Included Studies ........................................................................................................59 Findings ..........................................................................................................................................59 Research Question 5 .........................................................................................................................61 Evidence Base ................................................................................................................................61 Research Question 6 .........................................................................................................................62 Evidence Base ................................................................................................................................62 Summaries of Included Studies ..................................................................................................63 Quality of Included Studies ........................................................................................................67 Findings ..........................................................................................................................................68 Recommendations to FMCSA ..........................................................................................................72 Amount of Evidence ........................................................................................................................72 Appendices...........................................................................................................................................73 Works Cited (Included Studies) .....................................................................................................73 3 Executive Summary Introduction Driving a large commercial motor vehicle is dangerous work. In 2016, the Federal Motor Carrier Safety Administration (FMCSA) found that “4,440 large trucks and buses were involved in fatal crashes, a 2-percent increase from 2015”.1 In 2017, the Bureau of Labor Statistics (BLS) reported that truck drivers and delivery workers had the highest number of workplace fatalities (840), and that this “represented the highest value for heavy and tractor- trailer truck drivers” since reporting on those job types began in 2003.2 FMCSA’s primary mission is to reduce the number of crashes, injuries, and fatalities suffered by commercial motor vehicle (CMV) operators. FMCSA’s Medical Programs Division supports this mission by working to ensure that CMV drivers involved in interstate commerce are physically qualified and able to safely perform their work. As part of the effort to improve safety, the FMCSA periodically commissions systematic reviews of the scientific literature related to a variety of topics relevant to safe CMV operations. The results of these studies, combined with input from the FMCSA’s Medical Expert Panel, are used to inform agency decision-making and policy updates. This report considers the impact of seizure disorders