McLachlan Richard S, Starreveld Elout, Lee Mary Ann
Department of Clinical Neurological Sciences, University of Western Ontario, 339 Windermere Road, London, Canada.
Epilepsia. 2007 Aug;48(8):1500-5. doi: 10.1111/j.1528-1167.2007.01051.x. Epub 2007 Apr 18.
In some jurisdictions, physicians are required by law to report patients with seizures to the department of motor vehicles. We assessed the hypothesis that mandatory reporting reduces the risk of automobile accidents in people with epilepsy.
A retrospective survey of driving and accident rates was done by mailed questionnaire to two groups of subjects with epilepsy in Canada, one living in Ontario where reporting is mandatory and the other in Alberta where it is not. Responses were obtained from a control group without epilepsy for comparison.
The epilepsy (n = 425) and control (n = 375) groups were comparable in age and sex. Seventy-three percent of the epilepsy group were or had been licensed drivers compared to 94% of the controls (rr 0.77, 95% CI 0.73-0.83, p < 0.001). Lifetime accident rate of licensed drivers was 58% in epilepsy and 60% in controls (rr 0.99, 95%CI 0.82-1.19, ns) while 9% of the epilepsy group and 9% of the controls had an accident in the previous year (rr 1.00, 95%CI 0.95-1.06, ns). All those with epilepsy in Ontario (n = 202) and Alberta (n = 223), also comparable in age and sex, had equal lifetime accident rates of 45 and 46% (rr 0.99, 95%CI 0.67-1.47, ns) and 1-year rates of 11 and 8% (rr 1.38, 95%CI 0.59-3.27, ns). In Ontario, 20% of drivers were unlicensed compared to 9% in Alberta (rr 2.39, 95%CI 1.17-4.89, p = 0.01)
Although it is clearly dangerous for many people with ongoing seizures to drive, the findings provide no support for the hypothesis that mandatory reporting of patients by physicians reduces accident risk and suggest that concerns about the impact of epilepsy on driving compared to other medical and nonmedical risk factors may be excessive.
在某些司法管辖区，法律要求医生向机动车管理部门报告癫痫患者。我们评估了强制报告可降低癫痫患者发生汽车事故风险这一假设。
通过邮寄问卷对加拿大两组癫痫患者进行了驾驶和事故率的回顾性调查，一组居住在报告为强制性的安大略省，另一组居住在非强制性的艾伯塔省。从无癫痫的对照组获取答复进行比较。
癫痫组（n = 425）和对照组（n = 375）在年龄和性别上具有可比性。癫痫组中73%的人是或曾经是有驾照的司机，而对照组为94%（相对风险0.77，95%置信区间0.73 - 0.83，p < 0.001）。有驾照司机的终生事故率在癫痫组为58%，对照组为60%（相对风险0.99，95%置信区间0.82 - 1.19，无显著差异），而癫痫组9%的人和对照组9%的人在前一年发生了事故（相对风险1.00，95%置信区间0.95 - 1.06，无显著差异）。安大略省（n = 202）和艾伯塔省（n = 223）所有癫痫患者在年龄和性别上也具有可比性，终生事故率分别为45%和46%（相对风险0.99，95%置信区间0.67 - 1.47，无显著差异），1年事故率分别为11%和8%（相对风险1.38，95%置信区间0.59 - 3.27，无显著差异）。在安大略省，20%的司机无驾照，而艾伯塔省为9%（相对风险2.39，95%置信区间1.17 - 4.89，p = 0.01）
虽然许多癫痫发作未得到控制的人开车显然危险，但研究结果不支持医生强制报告患者可降低事故风险这一假设，表明与其他医学和非医学风险因素相比，对癫痫对驾驶影响的担忧可能过度。
