Department of Neurology and Neurological Research, St. Vincent's Hospital Melbourne, Melbourne, Australia.
Epilepsy Behav. 2010 Dec;19(4):608-11. doi: 10.1016/j.yebeh.2010.09.026. Epub 2010 Oct 29.
The use of prolonged video-electroencephalography monitoring (VEM), rather than routine electroencephalography (EEG), in predicting the risk of future seizures in patients with epilepsy is not well studied. A longer period of monitoring could be more likely to capture either ictal or interictal epileptiform activity. This information may better assist clinical decision making on driving fitness. The goal of this study was to evaluate the use of 6-hour prolonged VEM versus routine EEG in the assessment of future seizure risk and driving fitness for patients with epilepsy.
Data on consecutive patients referred for 6-hour prolonged VEM were retrospectively analyzed. Criteria were developed that combined EEG findings and clinical factors to determine each patient's fitness to drive. Seizure relapse outcomes were followed over 2 years.
Of 34 patients, 27 were considered safe to drive following prolonged VEM. Five (19%) of these 27 patients had seizure relapses; all had an obvious precipitant(s) identified including sleep deprivation, excessive alcohol, and missed medication doses. Seven of the 34 patients were deemed unsafe to drive. All seven (100%) had seizure relapses, with unprovoked seizures in four patients. The relative risk of seizure in patients deemed unfit to drive was 5.4 (P=0.00015). If only the routine EEG component of the recordings were used with the criteria, the relative risk would have been 3.4 (P=0.037), with nearly double the number of active drivers having seizures. The majority of patients (76%) in this study had idiopathic generalized epilepsy, with a relative seizure risk of 4.0 (P=0.002) for patients deemed unfit to drive in this subgroup. The focal epilepsy group was small (eight patients) and did not quite achieve statistical significance.
Six-hour VEM improves the evaluation of driving fitness by better predicting the risk of subsequent seizure relapse for idiopathic generalized epilepsy and possibly focal epilepsy. Prolonged monitoring is superior to routine EEG. Ongoing avoidance of seizure-provoking factors remains paramount to driving safety.
在预测癫痫患者未来癫痫发作风险方面，使用长时间视频脑电图监测（VEM）而不是常规脑电图（EEG）的效果尚未得到充分研究。较长时间的监测更有可能捕捉到发作期或发作间期的癫痫样活动。这些信息可能会更好地帮助临床决策是否适合驾驶。本研究的目的是评估 6 小时延长 VEM 与常规 EEG 在评估癫痫患者未来癫痫发作风险和驾驶适应性方面的作用。
回顾性分析了连续就诊进行 6 小时延长 VEM 的患者的数据。制定了结合 EEG 发现和临床因素的标准，以确定每位患者的驾驶适应性。随访了 2 年的癫痫复发结局。
34 例患者中，27 例经延长 VEM 后被认为可以安全驾驶。这 27 例中有 5 例（19%）出现癫痫复发；所有患者都确定了明显的诱发因素，包括睡眠剥夺、过度饮酒和漏服药物。34 例患者中有 7 例被认为不适合驾驶。这 7 例患者（100%）均出现癫痫复发，其中 4 例为无诱因发作。被认为不适合驾驶的患者发生癫痫的相对风险为 5.4（P=0.00015）。如果仅使用记录中的常规 EEG 部分并采用这些标准，则相对风险为 3.4（P=0.037），会有近一半的活跃驾驶员出现癫痫发作。本研究中大多数患者（76%）患有特发性全面性癫痫，在这个亚组中，被认为不适合驾驶的患者癫痫复发的相对风险为 4.0（P=0.002）。局灶性癫痫组较小（8 例），但未达到统计学意义。
6 小时 VEM 通过更好地预测特发性全面性癫痫和可能的局灶性癫痫患者随后癫痫复发的风险，改善了驾驶适应性的评估。延长监测优于常规 EEG。持续避免诱发癫痫的因素仍然是驾驶安全的关键。
