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Möller L, Krämer G, Habermehl L, Menzler K, Knake S. Driving regulations for epilepsy in Europe. Seizure 2023; 109:83-91. [PMID: 37276778 DOI: 10.1016/j.seizure.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Across Europe, there are differences regarding driving restrictions for patients with epilepsies and seizures. In the light of increasing mobility, knowledge about those different regulations is of high importance for counseling patients, and physicians. METHODS A structured online survey was sent to the official representatives of the different European ILAE chapters, asking for the local driving restrictions for patients with epilepsies, first seizures, syncopes, and psychogenic non-epileptic seizures. RESULTS The survey was sent to 38 chapters or representatives of 47 European Countries. 33 chapters answered. The majority of countries require 1 year of seizure-freedom for the ability to drive (Group 1, former categories A, B, B + E, F, G. H, K, L, and P; driving license which authorizes its holder to drive vehicle classes categories of the motor vehicle), usually with the need to continue antiseizure medication (ASM). Some countries have much stricter regulations before allowing for driving. Legal regulations after a first unprovoked seizure differ between 6 months for Group 1 license holders in most European countries, and one year in Luxembourg and Malta. In Serbia, there is no legal regulation for this special situation. The situation after a first seizure is even more complex for Group 2 license holders (former categories C1, C1+E, C, C + E, D1, D1+E, D, D + E). CONCLUSION Knowledge of the different recommendations of the individual European countries is of high relevance in the counseling of epilepsy patients. Europe-wide regulations, e.g. following the IBE-recommendations are needed to facilitate the patients' situation.
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Affiliation(s)
- Leona Möller
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany.
| | | | - Lena Habermehl
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Katja Menzler
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University Marburg, Marburg, Germany
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Lagrand TJ, Vaezipour A, Hill A, Horswill MS, Lehn AC. Hazard Perception Skill and Driver Behavior in Patients With Functional Neurologic Disorders. Neurology 2023; 100:e1248-e1256. [PMID: 36539297 PMCID: PMC10033169 DOI: 10.1212/wnl.0000000000206757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Driving in patients with functional neurologic disorders (FND) is a major concern, but current guidelines (where they exist) are based on expert consensus only due to a lack of relevant empirical evidence. This study aimed to provide such evidence by comparing drivers with FND with healthy controls on aspects of driving performance and behavior important to crash risk, including hazard perception skill. METHODS Participants completed validated self-report questionnaires of driving behaviors (assessing lapses, errors, violations, and attentional issues) and 2 computer-based measures of hazard perception skill (both known to be associated with crash risk). RESULTS We compared 43 patients who experience dissociative attacks or functional motor symptoms and 43 healthy controls. Patients with FND self-reported significantly more driving lapses and driving errors compared with healthy controls. However, there were no significant between-group differences in self-reports of ordinary violations, aggressive violations, or attention-related errors. Participants in the FND group and healthy controls exhibited a similar performance on a response time hazard perception test (6.27 vs 5.51 seconds, p = 0.245). However, participants with FND remarkably outperformed the controls in the number of plausible predictions they made in a verbal response hazard prediction test (1.55 vs 1.18 predictions per clip, p = 0.006). DISCUSSION Our findings suggest that the ability of drivers with FND to predict traffic hazards in between attacks or flares is not worse than that of healthy individuals, with the possibility that it might even be better under some circumstances. Further studies with various populations are needed to replicate our findings.
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Affiliation(s)
- Tjerk J Lagrand
- From the Department of Neurology (T.J.L., A.C.L.), Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; RECOVER Injury Research Centre (A.V.), The University of Queensland, Brisbane, Australia., Minerals Industry Safety and Health Centre, Sustainable Minerals Institute (A.H.), The University of Queensland, Brisbane, Australia; School of Psychology (A.H., M.S.H.), The University of Queensland, Brisbane, Australia., and School of Medicine (A.C.L.), The University of Queensland, Brisbane, Australia.
| | - Atiyeh Vaezipour
- From the Department of Neurology (T.J.L., A.C.L.), Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; RECOVER Injury Research Centre (A.V.), The University of Queensland, Brisbane, Australia., Minerals Industry Safety and Health Centre, Sustainable Minerals Institute (A.H.), The University of Queensland, Brisbane, Australia; School of Psychology (A.H., M.S.H.), The University of Queensland, Brisbane, Australia., and School of Medicine (A.C.L.), The University of Queensland, Brisbane, Australia
| | - Andrew Hill
- From the Department of Neurology (T.J.L., A.C.L.), Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; RECOVER Injury Research Centre (A.V.), The University of Queensland, Brisbane, Australia., Minerals Industry Safety and Health Centre, Sustainable Minerals Institute (A.H.), The University of Queensland, Brisbane, Australia; School of Psychology (A.H., M.S.H.), The University of Queensland, Brisbane, Australia., and School of Medicine (A.C.L.), The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- From the Department of Neurology (T.J.L., A.C.L.), Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; RECOVER Injury Research Centre (A.V.), The University of Queensland, Brisbane, Australia., Minerals Industry Safety and Health Centre, Sustainable Minerals Institute (A.H.), The University of Queensland, Brisbane, Australia; School of Psychology (A.H., M.S.H.), The University of Queensland, Brisbane, Australia., and School of Medicine (A.C.L.), The University of Queensland, Brisbane, Australia
| | - Alexander C Lehn
- From the Department of Neurology (T.J.L., A.C.L.), Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; RECOVER Injury Research Centre (A.V.), The University of Queensland, Brisbane, Australia., Minerals Industry Safety and Health Centre, Sustainable Minerals Institute (A.H.), The University of Queensland, Brisbane, Australia; School of Psychology (A.H., M.S.H.), The University of Queensland, Brisbane, Australia., and School of Medicine (A.C.L.), The University of Queensland, Brisbane, Australia
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Chrétien B, Nguyen S, Dolladille C, Morice PM, Heraudeau M, Loilier M, Fedrizzi S, Bourgine J, Cesbron A, Alexandre J, Bocca ML, Freret T, Lelong-Boulouard V. Association between road traffic accidents and drugs belonging to the antiseizure medications class: A pharmacovigilance analysis in VigiBase. Br J Clin Pharmacol 2023; 89:222-231. [PMID: 35939367 DOI: 10.1111/bcp.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Due to their central mechanism of action, antiseizure medications (ASMs) could lead to adverse effects likely to impair driving skills. Their extended use to neuropsychiatric disorders makes it a class of drugs to monitor for their road traffic accidental (RTA) potential. We aimed to assess the reporting association between ASMs and RTAs using the World Health Organization pharmacovigilance database (VigiBase). METHODS We performed a disproportionality analysis to compute adjusted reporting odds ratios to evaluate the strength of reporting association between ASMs and RTAs. A univariate analysis using the reporting odds-ratio was used to assess drug-drug interactions between ASMs and RTAs. RESULTS There were 1 341 509 reports associated with at least 1 ASM in VigiBase of whom 2.91‰ were RTAs reports. Eight ASMs were associated with higher reporting of RTAs compared to others (ranging from 1.35 [95% confidence interval 1.11-1.64] for lamotrigine to 4.36 [95% confidence interval 3.56-5.32] for cannabis). Eight significant drug-drug interactions were found between ASMs and the onset of RTA, mainly involving CYP450 induction. CONCLUSION A significant safety signal between RTAs and some ASMs was identified. Association of several ASMs might further increase the occurrence of RTA. ASMs prescription in patients with identified risk factors of RTA should be considered with caution. Study number: ClinicalTrials.gov, NCT04480996.
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Affiliation(s)
- Basile Chrétien
- Department of Pharmacology, Caen University Hospital, Caen, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, France
| | - Sophie Nguyen
- Department of Pharmacology, Caen University Hospital, Caen, France.,Department of Neurology, Caen University Hospital, Caen, France
| | - Charles Dolladille
- Department of Pharmacology, Caen University Hospital, Caen, France.,Normandie Univ, UNICAEN, INSERM U1086 ANTICIPE, CAEN, France
| | - Pierre-Marie Morice
- Department of Pharmacology, Caen University Hospital, Caen, France.,Normandie Univ, UNICAEN, INSERM U1086 ANTICIPE, CAEN, France
| | - Marie Heraudeau
- Department of Neurology, Caen University Hospital, Caen, France
| | - Magalie Loilier
- Department of Pharmacology, Caen University Hospital, Caen, France
| | - Sophie Fedrizzi
- Department of Pharmacology, Caen University Hospital, Caen, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, France
| | - Joanna Bourgine
- Department of Pharmacology, Caen University Hospital, Caen, France
| | | | - Joachim Alexandre
- Department of Pharmacology, Caen University Hospital, Caen, France.,Pharmacovigilance Regional Center, Caen University Hospital, Caen, France.,Normandie Univ, UNICAEN, INSERM U1086 ANTICIPE, CAEN, France
| | | | - Thomas Freret
- Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France
| | - Véronique Lelong-Boulouard
- Department of Pharmacology, Caen University Hospital, Caen, France.,Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France
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Markhus R, Henning O, Molteberg E, Hećimović H, Ujvari A, Hirsch E, Rheims S, Surges R, Malmgren K, Rüegg S, Gil-Nagel A, Roivainen R, Picard F, Steinhoff B, Marusic P, Mostacci B, Kimiskidis VK, Mindruta I, Jagella C, Mameniškienė R, Schulze-Bonhage A, Rosenow F, Kelemen A, Fabo D, Walker MC, Seeck M, Krämer G, Arsene OT, Krestel H, Lossius M. EEG in fitness to drive evaluations in people with epilepsy - Considerable variations across Europe. Seizure 2020; 79:56-60. [PMID: 32416569 DOI: 10.1016/j.seizure.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Epilepsy patients consider driving issues to be one of their most serious concerns. Ideally, decisions regarding fitness to drive should be based upon thorough evaluations by specialists in epilepsy care. In 2009, an EU directive was published aiming to harmonize evaluation practices within European countries, but, despite these recommendations, whether all epileptologists use the same criteria is unclear. We therefore conducted this study to investigate routine practices on how epileptologists at European epilepsy centers evaluate fitness to drive. METHODS A questionnaire was sent to 63 contact persons identified through the European Epi-Care and the E-pilepsy network. The questionnaire addressed how fitness-to-drive evaluations were conducted, the involvement of different professionals, the use and interpretation of EEG, and opinions on existing regulations and guidelines. RESULTS The questionnaire was completed by 35 participants (56 % response rate). Results showed considerable variation regarding test routines and the emphasis placed on the occurrence and extent of epileptiform discharges revealed by EEG. 82 % of the responders agreed that there was a need for more research on how to better evaluate fitness-to-drive in people with epilepsy, and 89 % agreed that regulations on fitness to drive evaluations should be internationally coordinated. CONCLUSION Our survey showed considerable variations among European epileptologists regarding use of EEG and how findings of EEG pathology should be assessed in fitness-to-drive evaluations. There is a clear need for more research on this issue and international guidelines on how such evaluations should be carried out would be of value.
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Affiliation(s)
- Rune Markhus
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway.
| | - Oliver Henning
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Ellen Molteberg
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
| | | | - Akos Ujvari
- Juhász Pál Epilepsy Centrum, National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Edouard Hirsch
- Neurology Department, University Hospital Strasbourg, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon's Neurosciences Research Center, Lyon, France
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Germany
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel, Switzerland
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber Internacional, Madrid, Spain
| | - Reina Roivainen
- Helsinki University Hospital, Neurocenter, Epilepsia Helsinki, Finland
| | - Fabienne Picard
- EEG and Epilepsy Unit, Department of Neurology, University Hospitals and Medical School of Geneva, Geneva, Switzerland
| | | | - Petr Marusic
- Department of Neurology, Charles University, Second Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Barbara Mostacci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioana Mindruta
- University Emergency Hospital of Bucharest, Epilepsy Monitoring Unit, Neurology Department, Bucharest, Romania
| | | | - Rūta Mameniškienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Zentrums der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Anna Kelemen
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Daniel Fabo
- Epilepsy Centrum, Department of Neurology, National Institute of Clinical Neurosciences, Budapest, Hungary
| | | | - Margitta Seeck
- Department for Clinical Neurosciences, HUG, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Oana Tarta Arsene
- Department of Pediatric Neuroloy, Al Obregia' Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Heinz Krestel
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany; Department of Neurology, Yale University School of Medicine, New Haven, USA
| | - Morten Lossius
- Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Norway
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Algahtani H, Shirah B, Algahtani R, Algahtani R. Epilepsy and driving: Local experience from Saudi Arabia. Epilepsy Behav 2019; 99:106401. [PMID: 31454705 DOI: 10.1016/j.yebeh.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving. METHODS This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire. RESULTS A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city. CONCLUSION This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raneem Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raghad Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Fang J, Jirsch J, Wang S, Zhou D, Mu J, An D, Si Y, Zhao G. Neurologists' attitudes toward driving among persons with epilepsy in China: A pilot electronic survey. Epilepsy Behav 2019; 94:47-51. [PMID: 30884407 DOI: 10.1016/j.yebeh.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE AND METHODS Persons with epilepsy (PWE) remain completely and permanently prohibited from driving in China currently. Previous studies have shown that a considerable proportion of PWE with uncontrolled seizures in China continue to drive motor vehicles. Discrepancy between Chinese policy and driving practices for PWE is potentially concerning. We conducted a preliminary online electronic questionnaire (e-questionnaire) survey among neurologists in China aiming to explore neurologists' attitudes toward the issue of driving among PWE. RESULTS A total of 358 neurologists completed the e-questionnaire with a response rate of 75.8%. 50.3% of neurologists stated that they knew the driving restriction law in China. With respect to reporting of cases to relevant driving authorities, 82.4% of neurologists never directly report PWE, and 90.8% consider that it is PWE's responsibility to report themselves. 87.4% of physicians surveyed indicated that the lack of clearly-articulated guidelines is a major impediment to their routine discussions of driving fitness for PWE. Subgroup analysis indicated that 76.2% of epileptologists were of the opinion that persons with well-controlled epilepsy should be allowed to drive versus 56.2% of general neurologists (P < 0.05). CONCLUSION Currently, neurologists in China have a low awareness of the legal driving restriction for PWE and have highly varying practices with respect to counseling PWE about driving. According to our preliminary results, a clearly-articulated published national document for medical fitness for driving in China is necessary in order to standardize physicians' practices.
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Affiliation(s)
- Jiajia Fang
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jeffrey Jirsch
- The Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Shuang Wang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Mu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Si
- Department of Neurology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Guohua Zhao
- Department of Neurology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China; Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Driving with drug-resistant and controlled seizures from a patient's perspective: Assessment of attitudes and practices. Epilepsy Behav 2018; 81:101-106. [PMID: 29449138 DOI: 10.1016/j.yebeh.2018.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/30/2017] [Accepted: 01/17/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Driving restrictions in epilepsy are intended to safeguard public and personal safety; however, these limitations inhibit socialization, restrict employment, and reduce self-esteem in patients with seizures. A large proportion of patients with seizures continue to drive, and factors leading to noncompliance with driving regulations are poorly understood. Thus, the patients' perspective on driving safety is not incorporated into the existing counseling tools on driving safety in epilepsy. The present study assessed social, economic, and psychological perceptions related to driving restrictions in patients with refractory and pharmacotherapy-controlled seizures at the single epilepsy center and identified impediments for safe driving. METHODS Data were obtained from an anonymous survey completed by 25 adult patients in the presurgical group (PG) with refractory epilepsy and 46 patients in the ambulatory group (AG) with confirmed epilepsy which did not meet criteria for refractoriness. The questionnaire (administered via Research Electronic Data Capture (REDCap)) addressed seizure and driving history, knowledge of driving restrictions, and social consequences of losing driving privileges. RESULTS Eighty-seven percent of all responders experienced seizures with alteration of awareness; however, 34% of patients continued to drive during the time when they were legally restricted, and 6% had accidents related to seizures. All responders reported their seizure status accurately to the treating physician, and 93% understood state-based driving restrictions. The median time from the last seizure was shorter, and the duration of last driving restriction was longer in the PG compared with the AG (1 vs. 20weeks, and 12 vs. 24weeks, respectively). Despite that, the proportions of patients driving at the time of survey were not significantly different between the two groups. Nearly 80% of all patients stated that driving restrictions reduced their quality of life, and 70% believed that these restrictions carry a social stigma. Employment was chosen to be the most affected by driving restrictions from a list of four social domains by the majority of patients in both groups. Notably, the employment rate was 26% higher in the AG compared with the PG. The lack of public transportation was regarded as a hurdle by more than 60% of patients in each group with greater than two-thirds of patients relying on other drivers for transportation. CONCLUSIONS These findings suggest that patients with refractory and pharmacotherapy-controlled seizures are similarly likely to drive a vehicle, disregarding a practitioner's advice and state restrictions. The lack of public transportation is a shared constraint and likely leads to reduced compliance with driving regulations. Driving restrictions carry social stigma and limit the employment of patients with epilepsy, regardless of the refractory seizure status.
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Nishina Y, Yoshioka SI. A Survey of Epilepsy-related Knowledge, Attitudes and Practices of Home Healthcare Nurses in the San-in Region of Japan. Yonago Acta Med 2018. [PMID: 29599618 DOI: 10.33160/yam.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Comprehensive care is necessary for people with epilepsy (PWE) to lead a fulfilling life at home and in the community. The purpose of this study was to determine the epilepsy-related knowledge, attitudes and practices of home healthcare nurses (HHNs) in the San-in region of Japan. Methods A questionnaire survey was conducted by mail of 546 HHNs working in Tottori and Shimane Prefectures. The questionnaire assessed the epilepsy-related knowledge, attitudes and practices of HHNs. For the analysis, simple and cross tabulation of questionnaire responses were conducted, and the chi-squared test was used for statistical testing. Results A total of 285 HHNs participated in the study. Of the respondents, 43.9% had experience taking care of PWE in a home healthcare nursing setting. Regarding the cause of epilepsy, in descending order the percentage of correct responses were 86.7% for stroke, 85.3% for head injury, and only 13.3% for dementia. Concerning how to respond to an epileptic seizure, almost all respondents answered correctly, but 29.8% gave the incorrect answer of "place something inside the mouth." Regarding the practices of HHNs in relation to caring for PWE, nurses scored 52.0% for collaborating with the attending physician, indicating the need for improvement. The score for "provide information about social resources" was low at 18.4%. Of the respondents, 95.8% answered that epilepsy-related knowledge and technical skills were necessary for home healthcare nursing practice, and 87.7% were interested in participating in a workshop on epilepsy. Conclusion The study revealed an inadequate level of knowledge of epilepsy with dementia and corresponding epileptic seizures, a low awareness of nursing care in collaboration with physicians, and the importance of providing information about social resources. There is a need to offer information and education on the latest knowledge about epilepsy to HHNs.
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Affiliation(s)
- Yuko Nishina
- Department of Nursing Care Environment and Mental Health, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shin-Ichi Yoshioka
- Department of Nursing Care Environment and Mental Health, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Mahmud S, Hwang ST. Understanding variability in driving recommendations for patients with seizures. Epilepsy Behav 2017; 77:44-49. [PMID: 29111501 DOI: 10.1016/j.yebeh.2017.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/01/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is lack of consensus regarding driving restrictions for patients with epilepsy. Regulations vary by state. New York State (NYS) recommends driving restrictions for one year in a person with an episode of loss of consciousness (LOC), with physician discretion. Often, providers make recommendations to permit their patients to drive after a shorter seizure-free period than proposed guidelines. The prevalence and reasons behind more lenient recommendations have not been elucidated. METHODS Forty-one neurologists were surveyed anonymously in Nassau County, New York. They were questioned about the length of recommended driving restrictions (≤1, 3, 6, or ≥12months) that they typically provide to patients with suspected seizures in different clinical scenarios and overall reasons for doing so. Data about level of training, setting of practice, use of antiepileptic drug (AED) levels, and electroencephalogram (EEG) were also collected. RESULTS Of the 41 neurologists surveyed, 72% reported recommending driving restrictions <12months for patients who experienced LOC, without a confirmed diagnosis of seizure. The majority also recommended driving restriction of <12months for other scenarios including acute symptomatic seizure, exclusively simple partial seizures, nocturnal seizures, psychogenic nonepileptic seizures (PNES), and seizures occurring with or during AED reduction. The most common rationale was to improve patient autonomy and independence. Less than a third of neurologists estimated that the majority of their patients were noncompliant with driving recommendations. CONCLUSION We found that many neurologists' recommendations for limiting driving for patients with seizure-related episodes are shorter than those recommended by NYS. Furthermore, as there are no specific guidelines for questionable epileptic scenarios and seizures occurring nocturnally or without LOC, this appears to contribute to substantial variability in the duration of recommended driving restrictions. This opens a broad discussion about approaches towards advising driving limitations in order to protect public and patient safety while maintaining patient autonomy.
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Affiliation(s)
- Sidrah Mahmud
- Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Sean T Hwang
- Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA.
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Allosteric Modulation of GABAA Receptors by an Anilino Enaminone in an Olfactory Center of the Mouse Brain. Pharmaceuticals (Basel) 2014; 7:1069-90. [PMID: 25525715 PMCID: PMC4276907 DOI: 10.3390/ph7121069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 12/28/2022] Open
Abstract
In an ongoing effort to identify novel drugs that can be used as neurotherapeutic compounds, we have focused on anilino enaminones as potential anticonvulsant agents. Enaminones are organic compounds containing a conjugated system of an amine, an alkene and a ketone. Here, we review the effects of a small library of anilino enaminones on neuronal activity. Our experimental approach employs an olfactory bulb brain slice preparation using whole-cell patch-clamp recording from mitral cells in the main olfactory bulb. The main olfactory bulb is a key integrative center in the olfactory pathway. Mitral cells are the principal output neurons of the main olfactory bulb, receiving olfactory receptor neuron input at their dendrites within glomeruli, and projecting glutamatergic axons through the lateral olfactory tract to the olfactory cortex. The compounds tested are known to be effective in attenuating pentylenetetrazol (PTZ) induced convulsions in rodent models. One compound in particular, KRS-5Me-4-OCF3, evokes potent inhibition of mitral cell activity. Experiments aimed at understanding the cellular mechanism underlying the inhibitory effect revealed that KRS-5Me-4-OCF3 shifts the concentration-response curve for GABA to the left. KRS-5Me-4-OCF3 enhances GABA affinity and acts as a positive allosteric modulator of GABAA receptors. Application of a benzodiazepine site antagonist blocks the effect of KRS-5Me-4-OCF3 indicating that KRS-5Me-4-OCF3 binds at the classical benzodiazepine site to exert its pharmacological action. This anilino enaminone KRS-5Me-4-OCF3 emerges as a candidate for clinical use as an anticonvulsant agent in the battle against epileptic seizures.
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Abstract
Background:Epilepsy is a common medical condition for which physicians perform driver fitness assessments. The Canadian Medical association (CMA) and the Canadian Council of Motor transportation administrators (CCMTA) publish documents to guide Canadian physicians’ driver fitness assessments.Objectives:We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions.Methods:We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians’ philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. Of the nine scenarios, CCMTA and CMA recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. Agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test.Results:Overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). For the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). A majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. The lack of consistency in respondents’ agreement attained statistical significance (p<0.001).Conclusions:Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. This study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada.
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Chen J, Yan B, Lu H, Ren J, Zou X, Xiao F, Hong Z, Zhou D. Driving among patients with epilepsy in West China. Epilepsy Behav 2014; 33:1-6. [PMID: 24561651 DOI: 10.1016/j.yebeh.2014.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/20/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was conducted to survey the driving status of PWE in West China and to explore the sociodemographic and clinical factors associated with driving. METHODS Between October 2012 and October 2013, all adult patients who came to our epilepsy clinic in the West China Hospital were invited to participate. Logistic regression was used to detect the patient factors associated with driving. RESULTS A total of 657 patients completed this study. We found that 128 (19.5%) of these patients had driven recently (during the past year); among them, 80 (62.5%) experienced at least one seizure in the previous year. A logistic regression suggested that age, being male, being married, having a higher personal income, experiencing no seizure while awake, and taking fewer antiepileptic drugs were independently associated with recent driving. CONCLUSION This study showed that a considerable proportion of patients continue driving despite uncontrolled seizures. More detailed and operational driving restrictions may be needed for patients in China in order to strike a better balance between patients' quality of life and public safety.
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Affiliation(s)
- Jiani Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Bo Yan
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Huajun Lu
- West China Medical School, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Jiechuan Ren
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Xuemei Zou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, People's Republic of China.
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Abstract
Diabetes affects over 25 million people in the United States, most of whom are over the age of 16 and many of whom are licensed to drive a motor vehicle. Safe operation of a motor vehicle requires complex interactions of cognitive and motor functions and medical conditions that affect these functions often will increase the risk of motor vehicle accidents (MVA). In the case of diabetes, hypoglycemia is the most common factor that has been shown to increase MVA rates. When people with diabetes are compared with nondiabetic controls, systematic analyses show that the relative risk of MVA is increased by between 12% and 19% (Relative Risk Ratio 1.12-1.19). In comparison, the RRR for attention deficit hyperactivity disorder is 4.4 and for sleep apnea is 2.4. Epidemiologic research suggests that patients at risk for hypoglycemia-related MVAs may have some characteristics in common, including a history of severe hypoglycemia or of hypoglycemia-related driving mishaps. Experimental studies also have shown that people with a history of hypoglycemia-related driving mishaps have abnormal counter-regulatory responses to hypoglycemia and greater cognitive impairments during moderate hypoglycemia.
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