The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia,
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia,
Neuroepidemiology. 2019;53(1-2):1-12. doi: 10.1159/000500599. Epub 2019 May 24.
Epilepsy influences the ability to drive. We undertook a systematic review to determine the prevalence of driving or holding a driver's license among people with seizures, the prevalence of traffic accidents among those who drive, and factors that may explain heterogeneity in these point estimates.
We followed MOOSE and PRISMA guidelines in searching 8 databases from inception to June 27, 2018. All published observational studies were included, with the exception of case-control studies where prevalence could not be determined, case reports, and studies with fewer than 50 participants. We assessed external and internal validity and quality of studies, produced forest plots, and conducted meta-regression in "Stata 13."
Data were available from 67 studies published between 1967 and 2018. Across the studies there was a wide range in the prevalence of driving (3-90%) and holding a driver's license (8-98%). Up to 39% of people with epilepsy drove in violation of restrictions. Prevalence of traffic accidents ranged from 0 to 61% following seizure onset, or in the past 1-5 years. The percentage of people with seizures who drove decreased as time since diagnosis increased (p = 0.01, adjusted R2 = 31%). The number of people with seizures who drove or held a driver's license appears to have increased over time (p = 0.02, adjusted R2 = 7%) but without a corresponding increase in the number of traffic accidents. There was considerable heterogeneity between studies related to definitions, design, and population differences.
There is considerable variation in the prevalence of driving after a diagnosis of epilepsy and in reported motor vehicle accidents. Further efforts are required to better understand the impact of epilepsy, and epilepsy surgery, on driving and road safety, especially where driving continues in violation of restrictions. Policy changes are needed to encourage the introduction of available and affordable alternatives for driving, for example, developing public transport networks, and promoting subsidy schemes to encourage use of public transport, taxis, Uber, and Lyft, among people experiencing seizures.
癫痫会影响驾驶能力。我们进行了一项系统评价，以确定患有癫痫的人开车或持有驾照的比例、这些人开车时发生交通事故的比例，以及可能解释这些点估计值差异的因素。
我们遵循 MOOSE 和 PRISMA 指南，从建库开始至 2018 年 6 月 27 日，在 8 个数据库中进行了搜索。纳入所有已发表的观察性研究，除了病例对照研究，因为在这些研究中无法确定患病率，以及病例报告和参与者少于 50 人的研究。我们评估了研究的外部和内部有效性和质量，生成了森林图，并在“Stata 13”中进行了荟萃回归。
数据来自 1967 年至 2018 年期间发表的 67 项研究。在这些研究中，驾驶（3-90%）和持有驾照（8-98%）的患病率差异很大。高达 39%的癫痫患者在驾驶时违反了限制。癫痫发作后或过去 1-5 年内发生交通事故的比例为 0-61%。随着诊断后时间的增加，患有癫痫的人开车的比例下降（p=0.01，调整后的 R2=31%）。随着时间的推移，患有癫痫的人开车或持有驾照的人数似乎有所增加（p=0.02，调整后的 R2=7%），但交通事故的数量没有相应增加。研究之间在定义、设计和人群差异方面存在很大的异质性。
癫痫诊断后开车的比例以及报告的机动车事故比例存在很大差异。需要进一步努力，以更好地了解癫痫及其手术对驾驶和道路安全的影响，特别是在继续违反限制条件下开车的情况下。需要政策改变，以鼓励引入可用的和负担得起的驾驶替代品，例如，开发公共交通网络，并促进补贴计划，以鼓励在癫痫患者中使用公共交通、出租车、优步和 Lyft。
