Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany.
Acta Neurol Scand. 2020 Dec;142(6):541-544. doi: 10.1111/ane.13327. Epub 2020 Aug 20.
Driving is one of the most important issues for patients with seizures. The 2009 European directive provides a framework for evaluating standard situations in assessing the ability to drive. Such a framework may not be sufficient for individual scenarios.
To analyse current data on seizure recurrence risks (RcRs) focusing on their potential implications for car driving issues (group 1).
We evaluated current studies and meta-analyses on RcR.
A meta-analysis of seizure-free patients who withdrew their medication (Lamberink et al Lancet Neurology 2017;16:523) created a nomogram and a web-based tool that allow estimating RcR in individual patients and thus to identify those in whom medication withdrawal is possible without the common driving ban during withdrawal. The 2-year prediction model of that meta-analysis has been recently externally tested and confirmed. A meta-analysis of patients with a first unprovoked seizure (Bonnett et al PloS ONE 2014;9:e99063) determined to which extent RcRs depend on established risk factors. The seizure-free period required to restart driving could be tailored according to the individual RcR.
These current studies allow estimating individual RcR more precisely and thus modifying periods of driving bans beyond the existing guidelines.
驾驶是癫痫患者最重要的问题之一。2009 年欧洲指令为评估驾驶能力的标准情况提供了一个框架。这种框架可能不足以应对个别情况。
分析目前关于癫痫复发风险（RcR）的数据，重点关注其对驾驶问题的潜在影响（第 1 组）。
我们评估了目前关于 RcR 的研究和荟萃分析。
一项对停药后无癫痫发作的患者（Lamberink 等人，柳叶刀神经病学 2017；16:523）进行的荟萃分析创建了一个列线图和一个基于网络的工具，可用于估计个体患者的 RcR，并确定那些在停药期间无需常见驾驶禁令即可停药的患者。该荟萃分析的 2 年预测模型最近已被外部验证和确认。一项关于首次无诱因癫痫发作患者的荟萃分析（Bonnett 等人，PLoS ONE 2014；9:e99063）确定了 RcR 在多大程度上取决于已确定的危险因素。可以根据个体的 RcR 来调整重新开始驾驶所需的无癫痫发作期。
这些目前的研究可以更精确地估计个体 RcR，从而在现有指南之外修改驾驶禁令的期限。
