Charmley Andrew Roy, Kimber Thomas, Mahant Neil, Lehn Alexander
Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Central Adelaide Neurology Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
BMJ Neurol Open. 2021 Dec 6;3(2):e000210. doi: 10.1136/bmjno-2021-000210. eCollection 2021.
There are currently no Australian guidelines to assist clinicians performing deep brain stimulation (DBS) procedures in setting postoperative driving restrictions.
We aimed to provide recommendations for post-DBS driving restrictions to guide practice in Australia.
A review of current Australian and international driving guidelines, literature regarding the adverse effects of DBS and literature regarding the long-term effect of neurostimulation on driving was conducted using Elton B Stephens Company discovery service-linked databases. Australian neurologists and neurosurgeons who perform DBS were surveyed to gain insight into existing practice.
No guidance on driving restrictions following DBS surgery was found, either in existing driving guidelines or in the literature. There was a wide difference seen in the rates of reported adverse effects from DBS surgery. The most serious adverse events (haemorrhage, seizure and neurological dysfunction) were uncommon. Longer term, there does not appear to be any adverse effect of DBS on driving ability. Survey of Australian practitioners revealed a universal acceptance of the need for and use of driving restrictions after DBS but significant heterogeneity in how return to driving is managed.
We propose a 6-week driving restriction for private licences and 6-month driving restriction for commercial licences in uncomplicated DBS. We also highlight some of the potential pitfalls and pearls to assist clinicians to modify these recommendations where needed. Ultimately, we hope this will stimulate further examination of this issue in research and by regulatory bodies to provide more robust direction for practitioners performing DBS implantation.
目前澳大利亚没有相关指南来协助临床医生在进行脑深部电刺激（DBS）手术后设定驾驶限制。
我们旨在为DBS术后驾驶限制提供建议，以指导澳大利亚的临床实践。
使用埃尔顿·B·斯蒂芬斯公司发现服务链接数据库，对当前澳大利亚和国际驾驶指南、关于DBS不良反应的文献以及关于神经刺激对驾驶长期影响的文献进行了综述。对进行DBS手术的澳大利亚神经科医生和神经外科医生进行了调查，以深入了解现有实践情况。
在现有驾驶指南或文献中均未发现有关DBS手术后驾驶限制的指导意见。DBS手术报告的不良反应发生率存在很大差异。最严重的不良事件（出血、癫痫发作和神经功能障碍）并不常见。从长期来看，DBS似乎对驾驶能力没有任何不良影响。对澳大利亚从业者的调查显示，大家普遍认可DBS术后需要并应实施驾驶限制，但在如何管理恢复驾驶方面存在显著差异。
我们建议，在无并发症的DBS手术中，私人驾照的驾驶限制为6周，商业驾照的驾驶限制为6个月。我们还强调了一些潜在的陷阱和要点，以帮助临床医生在需要时调整这些建议。最终，我们希望这将促使研究机构和监管机构进一步审视这个问题，为进行DBS植入手术的从业者提供更有力的指导方向。
