Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Faculty of Medicine, Hacettepe University, Sihhiye, Ankara 06100, Turkey.
Epilepsy Behav. 2019 Mar;92:5-13. doi: 10.1016/j.yebeh.2018.11.031. Epub 2018 Dec 21.
Generalized spike-wave discharges (SWDs) are the hallmark of generalized epilepsy on the electroencephalogram (EEG). In clinically obvious cases, generalized SWDs produce myoclonic, atonic/tonic, or absence seizures with brief episodes of staring and behavioral unresponsiveness. However, some generalized SWDs have no obvious behavioral effects. A serious challenge arises when patients with no clinical seizures request driving privileges and licensure, yet their EEG shows generalized SWD. Specialized behavioral testing has demonstrated prolonged reaction times or missed responses during SWD, which may present a driving hazard even when patients or family members do not notice any deficits. On the other hand, some SWDs are truly asymptomatic in which case driving privileges should not be restricted. Clinicians often decide on driving privileges based on SWD duration or other EEG features. However, there are currently no empirically-validated guidelines for distinguishing generalized SWDs that are "safe" versus "unsafe" for driving. Here, we review the clinical presentation of generalized SWD and recent work investigating mechanisms of behavioral impairment during SWD with implications for driving safety. As a future approach, computational analysis of large sets of EEG data during simulated driving utilizing machine learning could lead to powerful methods to classify generalized SWD as safe vs. unsafe. This may ultimately provide more objective EEG criteria to guide decisions on driving safety in people with epilepsy.
广泛棘波放电（SWD）是脑电图（EEG）上全身性癫痫的标志。在临床明显的情况下，广泛的 SWD 会引起肌阵挛、失张力/强直或失神发作，伴有短暂的凝视和行为无反应。然而，有些广泛的 SWD 没有明显的行为影响。当没有临床发作的患者请求驾驶特权和许可，但他们的 EEG 显示出广泛的 SWD 时，就会出现一个严重的挑战。专门的行为测试表明，在 SWD 期间反应时间延长或反应缺失，即使患者或家属没有注意到任何缺陷，这也可能构成驾驶危险。另一方面，有些 SWD 在某些情况下确实是无症状的，在这种情况下，不应限制驾驶特权。临床医生通常根据 SWD 持续时间或其他 EEG 特征来决定驾驶特权。然而，目前还没有经过实证验证的指南来区分对驾驶“安全”和“不安全”的广泛 SWD。在这里，我们回顾了广泛 SWD 的临床表现以及最近研究 SWD 期间行为障碍机制的工作，这些工作对驾驶安全具有重要意义。作为未来的一种方法，利用机器学习对模拟驾驶期间的大量 EEG 数据进行计算分析，可以为将广泛的 SWD 安全分类与不安全分类提供强大的方法。这最终可能为指导癫痫患者的驾驶安全决策提供更客观的 EEG 标准。
