Tierney Anna, MacDonald Allycia, Lee Judy, Dunne John W, Lawn Nicholas D
Neurology Department, Royal Perth Hospital, Perth, WA, Australia.
Neurology Department, Royal Perth Hospital, Perth, WA, Australia.
Epilepsy Behav. 2024 Dec;161:110037. doi: 10.1016/j.yebeh.2024.110037. Epub 2024 Sep 20.
Patients with epilepsy are ineligible to drive until seizure free for an appropriate period given the risk of a seizure-related motor vehicle accident. Driving restrictions also apply to patients after their first-ever seizure. However, it is unclear whether a longer period of non-driving is required if the first seizure occurred while driving. The association of a seizure with driving may have been by chance or due to a specific factor or trigger increasing the likelihood of a seizure. More data is required to inform driving restrictions.
This study was based on prospectively collected data of consecutive adults with a first-ever seizure seen at a hospital-based first seizure clinic between 2000 and 2015. We examined the clinical, EEG and imaging features of patients who were eligible to drive, comparing patients with their first seizure while driving (FSWD) to those who had an awake first seizure at other times (FSOT) to explore possible differences clinical features and likelihood of seizure recurrence, evaluated using survival analysis.
57 patients with a FSWD were compared to 1335 patients with FSOT. 80 % of FSWD resulted in loss of control of the vehicle, 64 % with a crash and almost half of patients sustaining an injury. Fifty of 57 FSWD were related to an unprovoked first seizure. FSWD patients had a higher cumulative likelihood of having a second seizure than FSOT patients (50.1 % vs 36.2 % at 1 year, 57.9 % vs 41.7 % at 2 years and 65.1 % vs 47.8 % at 5 years; p = 0.003), with the conditional risk of seizure recurrence only falling consistently below 2.5 %/month at twelve months after the first seizure. Independent predictors of seizure recurrence on multivariable analysis were epileptogenic lesion on imaging, unprovoked (vs acute symptomatic) first seizure, epileptiform abnormality on EEG, focal seizure; and for those with unprovoked first seizure, FSWD and higher Rankin score were also predictors.
First seizure whilst driving is an independent predictor of seizure recurrence for unprovoked seizures, supporting a longer period of seizure freedom before returning to driving.
鉴于癫痫患者存在与癫痫发作相关的机动车事故风险，在癫痫发作得到控制并经过适当一段时间之前，他们没有资格驾驶。驾驶限制也适用于首次发作后的患者。然而，如果首次发作发生在驾驶时，是否需要更长时间的禁止驾驶尚不清楚。癫痫发作与驾驶之间的关联可能是偶然的，也可能是由于特定因素或诱因增加了癫痫发作的可能性。需要更多数据来指导驾驶限制。
本研究基于2000年至2015年间在一家医院的首次癫痫发作诊所前瞻性收集的连续成年首次发作患者的数据。我们检查了符合驾驶条件的患者的临床、脑电图和影像学特征，将首次发作时正在驾驶的患者（FSWD）与其他时间清醒时首次发作的患者（FSOT）进行比较，以探讨可能的临床特征差异和癫痫复发的可能性，使用生存分析进行评估。
将57例FSWD患者与1335例FSOT患者进行比较。80%的FSWD导致车辆失控，64%发生碰撞，近一半患者受伤。57例FSWD中有50例与首次无诱因发作有关。FSWD患者第二次发作的累积可能性高于FSOT患者（1年时分别为50.1%对36.2%，2年时为57.9%对41.7%，5年时为65.1%对47.8%；p = 0.003），癫痫复发的条件风险仅在首次发作后12个月时持续降至每月2.5%以下。多变量分析中癫痫复发的独立预测因素是影像学上的致痫病变、无诱因（与急性症状性相对）首次发作、脑电图上的癫痫样异常、局灶性发作；对于首次无诱因发作的患者，FSWD和较高的Rankin评分也是预测因素。
驾驶时首次发作是无诱因发作癫痫复发的独立预测因素，支持在恢复驾驶前需要更长时间的无癫痫发作期。
