Krauss G L, Krumholz A, Carter R C, Li G, Kaplan P
Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Neurology. 1999 Apr 22;52(7):1324-9. doi: 10.1212/wnl.52.7.1324.
We identified clinical risk factors for seizure-related motor vehicle crashes in patients with epilepsy.
Current US laws permit epilepsy patients with controlled seizures to drive. These laws attempt to balance the important economic and social value of driving with the risk to public safety from seizure-related crashes. Various clinical factors are considered in these laws, particularly the seizure-free interval. Driving restrictions range from 3 to 18 months, however, and studies have not established how these various seizure-free intervals and other clinical factors influence the risk for seizure-related motor vehicle crashes.
We performed a retrospective case-control study to determine the influence of clinical risk factors associated with seizure-related motor vehicle crashes. Both "case" and "control" patients had epilepsy, drove, and were from the same clinic, but the cases differed in having had seizure-related crashes.
Fifty patients with epilepsy who crashed during seizures and 50 matched control patients were compared. Factors that significantly decreased the odds of patients with epilepsy having motor vehicle crashes due to seizures were: long seizure-free intervals, reliable auras, few prior nonseizure-related accidents, and having had their antiepileptic drugs (AEDs) reduced or switched. For example, patients who had seizure-free intervals > or = 12 months had a 93% reduced odds for crashing compared to patients with shorter intervals. Other findings were: 25% of patients had more than one seizure-related crash and 20% had missed an AED dose just prior to their crash. The majority (54%) of patients who crashed were driving illegally, with seizure-free intervals shorter than legally permitted.
Seizure-free intervals, the presence of reliable auras, AED therapy modifications, and a history of nonseizure-induced crashes should be considered when counseling patients with epilepsy on driving and when formulating driving regulatory policy. Case control studies of crashes due to seizures can help in assessing and monitoring such risks.
我们确定了癫痫患者与癫痫发作相关的机动车碰撞事故的临床风险因素。
美国现行法律允许癫痫发作得到控制的患者开车。这些法律试图在驾驶的重要经济和社会价值与癫痫发作相关碰撞事故对公共安全造成的风险之间取得平衡。这些法律考虑了各种临床因素，尤其是无癫痫发作间隔期。驾驶限制从3个月到18个月不等，然而，研究尚未确定这些不同的无癫痫发作间隔期和其他临床因素如何影响与癫痫发作相关的机动车碰撞事故风险。
我们进行了一项回顾性病例对照研究，以确定与癫痫发作相关的机动车碰撞事故相关临床风险因素的影响。“病例”和“对照”患者均患有癫痫、会开车且来自同一诊所，但病例组患者发生过与癫痫发作相关的碰撞事故，而对照组没有发生过。
对50例癫痫发作时发生碰撞事故的患者和50例匹配的对照患者进行了比较。显著降低癫痫患者因癫痫发作而发生机动车碰撞事故几率的因素包括：无癫痫发作间隔期长、有可靠的先兆、既往非癫痫发作相关事故少以及抗癫痫药物（AED）剂量减少或换药。例如，无癫痫发作间隔期≥12个月的患者与间隔期较短的患者相比，碰撞事故几率降低了93%。其他发现包括：25%的患者发生过不止一次与癫痫发作相关的碰撞事故，20%的患者在碰撞事故发生前漏服了一剂AED。发生碰撞事故的患者中，大多数（54%）是非法驾驶，其无癫痫发作间隔期短于法律允许的时间。
在为癫痫患者提供驾驶咨询以及制定驾驶监管政策时，应考虑无癫痫发作间隔期、是否存在可靠的先兆、AED治疗调整以及非癫痫发作所致碰撞事故史。癫痫发作导致碰撞事故的病例对照研究有助于评估和监测此类风险。
