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Introduction: The influence of medical conditions on the ability to drive safely is a matter of concern to both physicians and society. Satisfactory answers to the many questions are not yet available, because of methodological difficulties, including the inability to collect sufficiently large and representative samples of drivers with specific diseases, and to acquire reliable accident data. For epilepsy, the conclusions of scientific reports vary from ``there is little to worry about'' to an increased relative risk of 1.9. As a consequence, attitudes and regulations vary greatly throughout the world. Material and methods: A ten-year historical cohort register study of 159 patients with epilepsy and 559 controls individually matched for age, gender, place of residence, and exposure period. Recorded diagnoses of other relevant diseases led to exclusion. The outcome measure was treatment at the casualty department after an accident as a car driver. Results: Ten patients and five controls had been treated at the casualty department, the rate ratio per 1,000 person-years with exposure being 7.01 (CI 2.18-26.13). Discussion: This study showed that drivers with epilepsy seven times more often than healthy controls were treated at a casualty department after having a road traffic accident. In view of the small numbers of accidents and the surprising findings, the results must be interpreted cautiously. It is not advisable at this time to liberalise demands, but, on the other hand, drastic inferences regarding the patients' automobile driving should be avoided until the results have been further substantiated.

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