From the Tulane University Undergraduate School of Public Health and Tropical Medicine (B.B.), New Orleans, LA; Monash University School of Medicine (S.B.), Clayton, Australia; Department of Neurology (J.A.F.), NYU Langone Health, New York; and Department of Neurology (J.P.), University of Colorado School of Medicine, Aurora.
Neurology. 2023 Sep 26;101(13):e1370-e1375. doi: 10.1212/WNL.0000000000207464. Epub 2023 Jun 7.
To identify the type, frequency, and consequences of seizures while driving (SzWD) in people with epilepsy before diagnosis.
We performed a retrospective cohort study using the Human Epilepsy Project (HEP) to identify prediagnostic SzWD. Clinical descriptions from seizure diaries and medical records were used to classify seizure types and frequencies, time to diagnosis, and SzWD outcomes. Data were modeled using multiple logistic regression to assess for factors independently associated with SzWD.
32 prediagnostic SzWD were reported among 23/447 (5.1%) participants. Of them, 7 (30.4%) had more than 1. Six participants (26.1%) experienced SzWD as their first lifetime seizure. Most SzWD were focal with impaired awareness (n = 27, 84.4%). Of participants who had motor vehicle accidents (MVAs), 6 (42.9%) had no recollection. SzWD led to hospitalization in 11 people. The median time from first seizure to first SzWD was 304 days (IQR = 0-4,056 days). The median time between first SzWD and diagnosis was 64 days (IQR = 10-176.5 days). Employment was associated with a 3.95-fold increased risk of SzWD (95% CI 1.2-13.2, = 0.03), and nonmotor seizures were associated with a 4.79-fold increased risk (95% CI 1.3-17.6, = 0.02).
This study identifies the consequences of seizure-related MVAs and hospitalizations people experience before epilepsy diagnosis. This highlights the need for further research aimed at improving seizure awareness and improving time to diagnosis.
在癫痫诊断前，确定癫痫患者驾驶时发作（SzWD）的类型、频率和后果。
我们使用人类癫痫项目（HEP）进行了一项回顾性队列研究，以确定诊断前的 SzWD。使用发作日记和病历中的临床描述来对发作类型和频率、诊断时间和 SzWD 结果进行分类。使用多逻辑回归模型评估与 SzWD 独立相关的因素。
在 447 名参与者中的 23 名（5.1%）报告了 32 例诊断前 SzWD。其中，7 例（30.4%）超过 1 例。6 名参与者（26.1%）首次出现终身发作即为 SzWD。大多数 SzWD 为局灶性伴意识障碍（n = 27，84.4%）。在发生机动车事故（MVA）的参与者中，有 6 人（42.9%）无记忆。SzWD 导致 11 人住院。从首次发作到首次 SzWD 的中位时间为 304 天（IQR = 0-4056 天）。从首次 SzWD 到诊断的中位时间为 64 天（IQR = 10-176.5 天）。就业与 SzWD 的风险增加 3.95 倍相关（95%CI 1.2-13.2，=0.03），非运动性发作与风险增加 4.79 倍相关（95%CI 1.3-17.6，=0.02）。
本研究确定了癫痫诊断前人们经历的与发作相关的 MVA 和住院的后果。这突出表明需要进一步研究，旨在提高对发作的认识和缩短诊断时间。
