Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Singleton Park, SA2 8PP, UK.
J Neurol Neurosurg Psychiatry. 2010 Feb;81(2):130-5. doi: 10.1136/jnnp.2009.181438.
Who with sleep seizures is safe to drive? Driving law is controversial; ineligibility varies between individual US states and EU countries. Current UK driving law is strongly influenced by a single-centre study from 1974 where most participants were not taking antiepileptic drugs (AEDs). However, pure sleep-related epilepsy is often fully controlled on medication, and its withdrawal can provoke awake seizures. This systematic review asked, 'What is the risk of awake seizures in pure sleep-related epilepsy?' 9885 titles were identified; 2312 were excluded (not human or adult); 40 full texts were reviewed; six papers met our inclusion criteria; each of these six studies had a different pure sleep-related epilepsy definition. Using the largest prospective study, we were able to calculate next year's awake seizure chance (treated with antiepileptic medication). This was maximal in the second year: 5.7% (95% CI 3.0 to 10.4%). European licensing bodies including the UK's Driver and Vehicle Licensing Agency broadly accept a risk of less than 20% for Group 1 licensing. However, this study excluded patients with frontal-lobe epilepsies. Furthermore, follow-up (n=160) varied from 2 to 6 years, yet new awake seizures may occur even after 10-20 years of pure sleep-related epilepsy A paucity of evidence underpins present licensing law; current rulings would be difficult to defend if legally challenged. The law may be penalising people with pure sleep-related epilepsy without increased risk of awake seizures, while failing to identify subgroups at unacceptable risk of an awake seizure at the wheel.
哪些患有睡眠性癫痫的人可以安全驾驶？驾驶法律存在争议；在美国各州和欧盟国家之间，无资格驾驶的情况各不相同。目前英国的驾驶法律主要受到 1974 年一项单中心研究的影响，该研究中的大多数参与者并未服用抗癫痫药物（AEDs）。然而，单纯的睡眠相关癫痫通常可以通过药物完全控制，停药可能会引发清醒时的癫痫发作。这项系统评价提出了一个问题，“单纯睡眠相关癫痫患者清醒时发生癫痫发作的风险有多大？” 共确定了 9885 个标题；排除了 2312 个（非人类或成人）；审查了 40 份全文；有 6 篇论文符合我们的纳入标准；这 6 项研究中的每一项都有不同的单纯睡眠相关癫痫定义。使用最大的前瞻性研究，我们能够计算出下一年清醒时癫痫发作的几率（用抗癫痫药物治疗）。第二年的风险最高：5.7%（95%CI 3.0 至 10.4%）。包括英国驾驶员和车辆许可证管理局在内的欧洲许可机构普遍接受 Group 1 许可证的风险低于 20%。然而，这项研究排除了额叶癫痫患者。此外，随访（n=160）时间从 2 年到 6 年不等，但即使在单纯睡眠相关癫痫 10-20 年后，新的清醒时癫痫发作仍可能发生。目前的许可法律依据证据不足；如果受到法律质疑，现行裁决将难以辩护。该法律可能会惩罚那些没有清醒时癫痫发作风险增加的单纯睡眠相关癫痫患者，同时未能确定那些在清醒时驾驶时存在不可接受的癫痫发作风险的亚组。
