Abstracts

Rationale: When loss of consciousness occurs during epileptic seizures, the ability of affected individuals to lead normal lives is significantly limited. Until it can be shown that seizures are fully controlled, epileptic individuals are often restricted from driving. Often, physicians play an important role in determining whether or not the patient should be allowed to drive since U.S. driving license issuance is dependent on people living with epilepsy maintaining a seizure free period. Decisions about a patient driving can be difficult, especially due to the lack of objective data that is available regarding patient driving performance during ictal and postictal clinical seizure periods. In addition effects on driving safety, when influenced by subclinical epileptiform discharges, are not known. Methods: In this study, we looked at patients undergoing video/EEG monitoring in the epilepsy monitoring unit at Yale New Haven Hospital analyzing ictal and interictal driving data captured prospectively from a driving simulator. A total of 33 seizures in 20 patients were analyzed, along with 143 subclinical epileptiform discharges in 9 patients and performance data was analyzed with attention to ictal and interictal periods of play. Interictal driving performance was defined as baseline and compared to ictal driving performance through quantitative analysis. Variables used in analysis included car velocity, steering wheel movement, application of the brake pedal and crash occurrence during the ictal and postictal periods as well as during subclinical epileptiform discharges. Results: Variable impairment both during seizure/postictal periods as well as during subclinical epileptiform discharges was found. Some seizures showed obvious impairment and others showed no change in driving performance. Seizures with driving impairment had significantly greater duration and were more likely to involve impaired consciousness than seizures without driving impairment (p < 0.05). Conclusions: Testing of driving inpatient video/EEG monitoring may be a useful way to determine factors that influence driving safety. We found that seizure duration and impaired consciousness are potentially important factors influencing driving performance. With further work, we hope to expand upon our current analysis and determine whether specific seizure types or localizations present a greater driving risk, with the goal of providing improved guidance to physicians and patients with epilepsy. Funding: N/A