Abstracts

Rationale:
: Restriction of driving is a serious concern for people with epilepsy. Decisions concerning eligibility for driving are informed mostly by retrospective studies, looking at motor vehicle accidents in people with epilepsy compared to normal controls. Few studies have attempted to prospectively examine the ability of people to drive while experiencing seizures. We aim to observe driving behavior directly during epileptic seizures using a driving simulator in the epilepsy monitoring unit, in order to relate seizure characteristics to ictal driving impairment.
Method:
Patients undergoing video-EEG monitoring in the Yale New Haven Hospital were tasked with using a realistic driving simulator, with explicit instructions to attempt to continue driving when a seizure occurred. Driving impairment, patient consciousness state, and motor impairment were evaluated via video review, monitoring summaries, and physician notes. Seizure events were classified as being focal seizures with or without impaired awareness, generalized motor seizures, or generalized spike-wave discharges without motor activity. Analysis was performed to determine whether seizure type, impaired consciousness awareness, or impaired motor function were associated with driving impairment.
Results:
We analyzed a total of 51 seizure events in 28 patients. We found that generalized motor seizures (5/5) and focal seizures with loss of conscious awareness (11/11) always led to driving impairment while focal seizures without loss of conscious awareness (0/10) never led to driving impairment. Generalized spike wave discharges without motor activity were rarely associated with driving impairment (1/24). In addition, focal seizures with motor involvement always lead to impaired driving (8/8) while those without motor involvement usually did not (10/14).
Conclusion:
These findings suggest that both impaired conscious awareness and abnormal motor function during seizures contribute to impaired driving. We found that seizure types with impaired conscious awareness or altered motor function usually impair driving ability. It will be important to expand this work in a larger cohort and to determine how these results with a driving simulator may translate into real world driving safety. Further prospective studies would provide a better understanding of which individuals should be allowed to drive and stand to improve quality of life for people with epilepsy.
Funding:
:N/A