Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
Epilepsy Behav. 2019 Feb;91:86-89. doi: 10.1016/j.yebeh.2018.04.008. Epub 2018 May 9.
Epilepsies are a common and chronic neurological disorder characterized by sustained risk of recurrent seizures. Because of paroxysmal and often unpredictable occurrence of seizures, patients with uncontrolled epilepsy are subject to disease-specific restrictions in daily life, such as their career choice or specific work limitations. According to German law and many other European and international guidelines, driving is strictly prohibited in patients with uncontrolled epilepsy so as to increase active and passive safety in public road traffic. Nevertheless, a significant percentage of patients probably do not comply with these legal restrictions and drive on a regular basis. For this study, we analyzed a representative German cohort with 302 patients (mean age: 45.0 years ± 16.4; 48% male) with established epilepsy to identify the number of patients driving without permission. Overall, 58.6% (n = 177) of patients had a driving license, 71.1% (n = 69/97) of patients were in seizure remission, and 52.7% (n = 108/205) of patients had uncontrolled epilepsy. Among patients in seizure remission, 54.6% (n = 53/97) reported regular driving while, among patients with uncontrolled epilepsy, 15.1% (n = 31/205) reported driving on a regular basis. No patient in the cohort stated driving without a valid license. Permanent employment, freelance work, the absence of a relevant disability, and living alone were identified as significant risk factors, which underlines the already existing evidence for the importance of a possible restricted access to the labor market as motive for disregarding legal driving restrictions. In our opinion, specialized and generally available social counseling with a special focus on vocational and career guidance is urgently needed to improve compliance with epilepsy-caused driving restrictions and the underlying reasons for violating these rules. In addition, more effort has to be spent on improving diagnostics and treatment of epilepsy to reduce the number of patients with uncontrolled seizures. Comprehensive introduction of self-driving vehicles may also help to improve mobility of patients with refractory epilepsy.
癫痫是一种常见的慢性神经系统疾病，其特征是持续存在反复发作的风险。由于癫痫发作具有阵发性和经常不可预测的特点，因此未经控制的癫痫患者在日常生活中会受到疾病特异性限制，例如职业选择或特定工作限制。根据德国法律和许多其他欧洲和国际指南，未经控制的癫痫患者严格禁止驾驶，以提高公共道路交通中的主动和被动安全性。然而，仍有相当一部分患者可能不遵守这些法律限制，经常开车。在这项研究中，我们分析了一个由 302 名患者组成的具有代表性的德国队列（平均年龄：45.0 ± 16.4 岁；48%为男性），以确定未经许可驾驶的患者人数。总体而言，58.6%（n=177）的患者有驾驶执照，71.1%（n=69/97）的患者处于癫痫缓解期，52.7%（n=108/205）的患者癫痫发作未得到控制。在癫痫缓解期的患者中，54.6%（n=53/97）报告经常开车，而在癫痫未得到控制的患者中，15.1%（n=31/205）报告经常开车。队列中没有患者表示无有效驾照驾驶。固定就业、自由职业、无相关残疾和独居被确定为显著风险因素，这突显了限制进入劳动力市场可能作为无视法律驾驶限制的动机的重要性。在我们看来，迫切需要提供专门的和普遍可用的社会咨询服务，特别关注职业和职业指导，以提高对癫痫引起的驾驶限制的遵守情况以及违反这些规则的根本原因。此外，还需要更加努力改善癫痫的诊断和治疗，以减少未经控制的癫痫发作患者的数量。全面引入自动驾驶汽车也可能有助于改善耐药性癫痫患者的移动性。
