Abstracts

Rationale: In New Jersey, patients who have seizures (including those with PNES) lose driving privileges and are not permitted to resume driving unless they have achieved six months of seizure freedom.  In this retrospective study, we examined the relationship between reported mood and anxiety symptoms in patients diagnosed with PNES who formally requested to regain driving privileges.  It was hypothesized that those patients wishing to resume their driving would demonstrate significantly lower levels of depression and anxiety as they were experiencing half a year of seizure-freedom and aspiring to increased independence and mobility.  The underlying assumption was that seizure freedom might bring about increased hopefulness and improvements in mental health.  Another assumption was that applying for reinstatement of privileges might contribute to improvements in mental health, due to the imminent possibility for independence.

Methods: A subset of patients diagnosed with PNES (2018 to 2021) at the Northeast Regional Epilepsy Group were included in the study.  Exclusion criteria included 1) patients diagnosed with PNES and epilepsy and 2) PNES patients younger than age 18 years (age of unrestricted driving in NJ).  Requests for reinstatement of driving privileges (requiring six months seizure freedom in NJ) were noted, and scores for self-report questionnaires - the Center for Epidemiologic Studies - Depression (CES-D) and State Trait Anxiety Inventory (STAI) were collected.

Results: A total of 75 patients with a history of PNES were examined.  Of those, 24 had submitted paperwork for reinstatement of driving privileges.  Comparisons were made using t-tests.  Results demonstrated a significant difference in reported level of depression symptoms (CES-D, p=0.01) between those who had submitted for reinstatement of privileges (less depressed) and those who had not.  No significant difference was found for reported level of anxiety on the STAI (STAI-trait, P=0.13) between the two groups.

Conclusions: The resumption of driving privileges has important implications for patients who have had this privilege suspended because the patient may be able to return to work or school, take care of personal and family needs, and generally increase independence.  Our findings demonstrated significantly lower depression symptoms for those patients with PNES who had applied for reinstatement of driving privileges than those who did not.  We speculate that perhaps a long stretch of seizure freedom may have resulted in improved mood.  Also, a lowering in depressive symptoms may have fostered the desire to become more independent and active.  Future research directions might examine other potential differences between patients who resume driving versus those who do not.  Driving may be an important factor to include in a treatment plan and to measure in treatment outcomes.

Funding: Dr. Krámská received funding from the Ministry of Health of the Czech Republic Grant MH- CZ and DRO (NNH, IG223001 and IG19300)