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Lawn ND, Pang EW, Lee J, Dunne JW. First seizure from sleep: Clinical features and prognosis. Epilepsia 2023; 64:2714-2724. [PMID: 37422912 DOI: 10.1111/epi.17712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Patients with a first-ever unprovoked seizure commonly have subsequent seizures and identifying predictors of recurrence has important management implications. Both prior brain insult and epileptiform abnormalities on electroencephalography (EEG) are established predictors of seizure recurrence. Some studies suggest that a first-ever seizure from sleep has a higher likelihood of recurrence. However, with relatively small numbers and inconsistent definitions, more data are required. METHODS Prospective cohort study of adults with first-ever unprovoked seizure seen by a hospital-based first seizure service between 2000 and 2015. Clinical features and outcomes of first-ever seizure from sleep and while awake were compared. RESULTS First-ever unprovoked seizure occurred during sleep in 298 of 1312 patients (23%), in whom the 1-year cumulative risk of recurrence was 56.9% (95% confidence interval [CI] 51.3-62.6) compared to 44.2% (95% CI 41.1-47.3, p < .0001) for patients with first-ever seizure while awake. First-ever seizure from sleep was an independent predictor of seizure recurrence, with a hazard ratio [HR] of 1.44 (95% CI 1.23-1.69), similar to epileptiform abnormalities on EEG (HR 1.48, 95% CI 1.24-1.76) and remote symptomatic etiology (HR 1.47, 95% CI 1.27-1.71). HR for recurrence in patients without either epileptiform abnormalities or remote symptomatic etiology was 1.97 (95% CI 1.60-2.44) for a sleep seizure compared to an awake seizure. For first seizure from sleep, 76% of second seizures also arose from sleep (p < .0001), with 65% of third seizures (p < .0001) also from sleep. Seizures from sleep were less likely to be associated with injury other than orolingual trauma, both with the presenting seizure (9.4% vs 30.6%, p < .0001) and first recurrence (7.5% vs 16.3%, p = .001). SIGNIFICANCE First-ever unprovoked seizures from sleep are more likely to recur, independent of other risk factors, with recurrences also usually from sleep, and with a lower risk of seizure-related injury. These findings may inform treatment decisions and counseling after first-ever seizure.
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Affiliation(s)
- Nicholas D Lawn
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Elaine W Pang
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Judy Lee
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - John W Dunne
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
- Discipline of Internal Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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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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Akhtar S, Aldhafeeri E, Alshammari F, Jafar H, Malhas H, Botras M, Alnasrallah N. A proportional odds model of risk behaviors associated with recurrent road traffic crashes among young adults in Kuwait. BMC Med Res Methodol 2022; 22:19. [PMID: 35026988 PMCID: PMC8759274 DOI: 10.1186/s12874-021-01497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background The aims of this cross-sectional study were to i) assess one-year period prevalence of one, two, three or more road traffic crashes (RTCs) as an ordinal outcome and ii) identify the drivers’ characteristics associated with this ordinal outcome among young adult drivers with propensity to recurrent RTCs in Kuwait. Methods During December 2016, 1465 students, 17 years old or older from 15 colleges of Kuwait University participated in this cross-sectional study. A self-administered questionnaire was used for data collection. One-year period prevalence (95% confidence interval (CI)) of one, two, three or more RTCs was computed. Multivariable proportional odds model was used to identify the drivers’ attributes associated with the ordinal outcome. Results One-year period prevalence (%) of one, two and three or more RTCs respectively was 23.1 (95% CI: 21.2, 25.6), 10.9 (95% CI: 9.4, 12.6), and 4.6 (95% CI: 3.6, 5.9). Participants were significantly (p < 0.05) more likely to be in higher RTCs count category than their current or lower RCTs count, if they habitually violated speed limit (adjusted proportional odds ratio (pORadjusted) = 1.40; 95% Cl: 1.13, 1.75), ran through red lights (pORadjusted = 1.64; 95%CI: 1.30, 2.06), frequently (≥ 3) received multiple (> 3) speeding tickets (pORadjusted = 1.63; 95% CI: 1.12, 2.38), frequently (> 10 times) violated no-parking zone during the past year (pORadjusted = 1.64; 95% CI: 1.06, 2.54) or being a patient with epilepsy (pORadjusted = 4.37; 95% CI: 1.63, 11.70). Conclusion High one-year period prevalence of one, two and three or more RTCs was recorded. Targeted education based on identified drivers’ attributes and stern enforcement of traffic laws may reduce the recurrent RTCs incidence in this and other similar populations in the region.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
| | - Eisa Aldhafeeri
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Farah Alshammari
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Hana Jafar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Haya Malhas
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Marina Botras
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
| | - Noor Alnasrallah
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait
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Anselme DA, Alassane D, Adeline KJM, Emérance EL, Christian N, Athanase M, Kapouni K, Jean K. Knowledge and attitudes of driver license applicants and instructors about driving of patients with epilepsy in Burkina Faso. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-021-00072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epilepsy is the most common neurological disease in the world. The objective of the study was to determine the knowledge, attitude and practice of driver’s license applicants and instructors in driving schools on epilepsy in Burkina Faso.
Method
This cross-sectional study was carried out from January 7th to March 7th 2020 in 21 driving schools approved by the National Driver License Authority in the city of Ouagadougou. Fifteen driver applicants and one instructor were selected in each driving school, resulting in a total of 315 driver applicants and 21 instructors in the study.
Results
The mean age of participants was 29.91 ± 7.63 years. One of the driver applicants included in the study was once experienced a seizure attack. All respondents had heard of epilepsy. The main source of epilepsy information was from family (42.5%). Two hundred and twenty-six respondents (67.3%) had witnessed an epileptic seizure. A majority of participants (55.9%) believed that persons with epilepsy be not permitted to drive a motor vehicle. About 44.0% of participants thought that people with epilepsy should be permitted to drive under certain conditions. One hundred and four (30.9%) participants suggested that people with epilepsy be permitted to drive a light vehicle. One hundred and forty-one (42.0%) suggest to withdraw the driving license for lifetime if a driver had an epileptic seizure attack; while twenty-three (6.8%) participants recommended suspension of driver license for 12 months.
Conclusion
Efforts should be made to improve awareness and education among license applicants and instructors on the driving by people with epilepsy.
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Nishida T, Kawai K, Tachimori H. Risks of seizure with fatal traffic crash at wheel in people with epilepsy. Seizure 2020; 76:110-115. [PMID: 32062321 DOI: 10.1016/j.seizure.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The Japanese authorities require a 2-year seizure-free period for a driver's license in people with epilepsy. To evaluate the stringency of the criteria, we calculated the risk of fatal traffic crashes by epileptic seizure and compared that to the risk of fatal traffic crashes among the general population. METHODS Nation-wide questionnaire surveys to physicians and their patients with epilepsy were conducted to determine the rate of seizure recurrence after given seizure-free periods, average driving time and the rate of traffic crashes by epileptic seizures. The risk of fatal traffic crashes by epileptic seizures was calculated using the method proposed by the Driving License Committee of the EU. The risk of fatal traffic crashes among subgroups of the general population was calculated using the national statistics available. RESULTS Valid answers were obtained from a total of 548 patients of 138 epilepsy-specialists and 102 non epilepsy-specialist physicians. The relative risks of fatal traffic crashes in people with epilepsy with 1-year and 2-year seizure-free periods were 1.22 and 1.15, compared to the general population, while the ones in males in their twenties, people aged 60 and over, people aged 65 and over, and people aged 75 and over among the general population were 1.71, 1.31, 1.52 and 2.69, respectively. CONCLUSION The risk of fatal traffic crashes in people with epilepsy for 1-year and 2-year seizure-free periods was estimated to be lower than that of some age groups in the general population. The increased risk in 1-year seizure freedom from that in 2-year seizure freedom was relatively small.
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Affiliation(s)
- Takuji Nishida
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan
| | - Kensuke Kawai
- Epilepsy Center and Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan
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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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Joshi CN, Vossler DG, Spanaki M, Draszowki JF, Towne AR. "Chance Takers Are Accident Makers": Are Patients With Epilepsy Really Taking a Chance When They Drive? Epilepsy Curr 2019; 19:221-226. [PMID: 31328536 PMCID: PMC6891831 DOI: 10.1177/1535759719858647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This review compiles scientific data about the real dangers faced by people with
epilepsy (PWE) who drive. Those include risks of motor vehicle accidents (MVA)
in PWE as compared with controls (individuals without epilepsy) and as compared
with persons with other medical conditions that impact fitness to drive. Data
regarding Accident rates as related to seizure free intervals (SFI), single vs.
multiple seizure events, and/or antiseizure drug (ASD) taper and reintroduction
are discussed. Variation in state, national, and international laws and guidance
for non-commercial and commercial drivers is highlighted, along with some
related reasons for driving restrictions. The review concludes by emphasizing
the importance of physicians educating patients about local driving laws and
about risks of ASD non-adherence. The need for a broader, multi-stakeholder
re-examination of driving regulations for PWE is noted.
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Affiliation(s)
- Charuta N Joshi
- 1 Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - David G Vossler
- 2 UW Medicine
- Valley Medical Center and University of Washington, Seattle, WA, USA
| | - Marianne Spanaki
- 3 Department of Neurology, Wayne State University, Detroit, MI, USA
| | | | - Alan R Towne
- 5 Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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Somerville ER. A decision tree to determine fitness to drive in epilepsy: Results of a pilot in two Australian states. Epilepsia 2019; 60:1445-1452. [PMID: 31111469 DOI: 10.1111/epi.16020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/17/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Certification by treating physicians of fitness to drive in people with epilepsy creates a conflict of interest that may result in unsafe decisions, damage the doctor-patient relationship, expose the physician to legal liability and prevent optimal treatment. Ideally, the treating physician should provide objective clinical information to the driver licensing authority (DLA), which then determines fitness or otherwise. However, DLAs in Australia do not employ medical staff and the national standards are complex. Fitness is determined by the treating physician, according to published national standards. The purpose of this study was to determine the feasibility of using a decision tree to determine fitness, according to the Australian standards. METHODS A decision tree was constructed to use clinical data to determine whether a patient met the national standard to drive a private motorcar, failed to meet it or required further assessment. A form was designed to collect the necessary clinical data from the treating physician. A computerized version of the decision tree was then used in a pilot in two Australian states in parallel with the existing certification system. Four hundred thirty-nine drivers with declared epilepsy and their treating physicians were invited to participate when their annual driver licence review was due. RESULTS Two hundred fifty-three (58%) forms were returned. All patients were considered fit to drive by their physician. Seventy-six percent had not had a seizure for over two years. In 88.1%, there was agreement between the decision tree and treating physician, with 3.6% identified by the decision tree as requiring review. Although considered fit by their physician, 6.3% did not meet the national standard to drive. SIGNIFICANCE The decision tree model is a practical alternative to fitness certification by treating physicians. This Australian pilot can serve as a model for applying objective standards to driving assessments in other jurisdictions, using local driving standards. It has the potential to improve road safety by avoiding the negative effects of certification by treating physicians and can cope with complex standards. It is now in use in two states of Australia.
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Affiliation(s)
- Ernest R Somerville
- Prince of Wales Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Xu Y, Zhou Z, Shanthosh J, Hackett ML, Anderson CS, Glozier N, Somerville E. Who is driving and who is prone to have traffic accidents? A systematic review and meta-analysis among people with seizures. Epilepsy Behav 2019; 94:252-257. [PMID: 30978638 DOI: 10.1016/j.yebeh.2019.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Epilepsy influences the ability to drive. We aimed to systematically summarize factors associated with driving, holding a driver's license, and traffic accidents among people with seizures. MATERIAL AND METHODS Eight databases were searched (from their inception to 27 June 2018). We included all published observational studies, except for case reports and studies with fewer than 50 participants. Pooled mean differences and pooled risk ratios (pRRs) with corresponding confidence intervals (CIs) were calculated using random effects. RESULTS Data were available from 18 studies, reporting a wide range of factors. There were frequent biases associated with cross-sectional study designs, selection bias, poor statistical quality, small samples, and lack of validation of models. The following six variables were consistently associated with driving: male gender (pRR: 1.42; 95% CI: 1.23 to 1.64), being in paid work (pRR: 1.72; 95% CI: 1.46 to 2.03), married (pRR: 1.26; 95% CI: 1.01 to 1.57), older age at seizure onset or diagnosis (pooled mean difference: 4.83; 95% CI: 0.48 to 9.18 years), less frequent seizures (fewer than monthly, pRR: 1.32; 95% CI: 1.12 to 1.56), and taking one or no antiepileptic drug (pRR: 1.34; 95% CI: 1.09 to 1.63). Lower seizure frequency was also protective for avoiding traffic accidents (pRR: 0.26; 95% CI: 0.10 to 0.66). DISCUSSION Stable multivariate models to predict driving or traffic accidents among people with seizures have not yet been developed. Current evidence shows that the likelihood of driving is associated with demographic and epilepsy-related factors, while the risk of traffic accidents is associated with seizure frequency.
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Affiliation(s)
- Ying Xu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia.
| | - Zien Zhou
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Pudong New District, Shanghai 200127, PR China.
| | - Janani Shanthosh
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia.
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia.
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia; The George Institute for Global Health at Peking University Health Science Centre, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing 100088, PR China.
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, 94 Mallett St., Camperdown, NSW 2050, Australia.
| | - Ernest Somerville
- Neurology Department, Prince of Wales Clinical School, University of New South Wales, Barker St., Randwick, NSW 2031, Australia.
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Aldhafeeri E, Alshammari F, Jafar H, Malhas H, Botras M, Alnasrallah N, Akhtar S. Period prevalence and factors associated with road traffic crashes among young adults in Kuwait. Injury 2018; 49:939-944. [PMID: 29402428 DOI: 10.1016/j.injury.2018.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/06/2018] [Accepted: 01/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This cross-sectional study assessed one-year period prevalence of road traffic crashes (RTCs) and examined the factors associated with RTCs among young adults in Kuwait. DESIGN AND SETTINGS During December 2016, 1500 students enrolled in 15 colleges of Kuwait University were invited to participate in the study. Students 18 years old or older and who drive by themselves were eligible. Data were collected using a structured self-administered questionnaire. One-year period prevalence of RTCs (≥1 vs. none) was computed. Multivariable log-binomial regression model was used to identify the risk factors associated with one-year period prevalence of RTCs. RESULTS Of 1500 invited individuals, 1465 (97.7%) participated, of which 71.4% (1046/1465) were female, 56.4% (804/1426) were aged between 21 and 25 years, and 67.1% (980/1460) were Kuwaitis. One-year period prevalence of RTC was 38.9%. The final multivariable log-binomial regression model showed that after adjusting for the influences of other variables in the model, participants were more likely to have had at least one RTC during the past year, if they habitually sped over limit (adjusted PR = 1.19; 95% confidence interval (CI): 1.04-1.36), crossed a red light (adjusted PR = 1.33; 95% CI: 1.16-1.52), or if they have had three or more speeding tickets (adjusted PR = 1.40; 95% CI: 1.13-1.73) compared to those who reportedly had no RTC during the same period. CONCLUSION One-year period prevalence of RTCs among university students in Kuwait, though relatively lower than the reported figures in similar populations elsewhere in the region, is yet high enough to warrant diligent attention. Habitual speeding, having had three or more speeding tickets, and the practice of crossing a red light were significantly and independently associated with at least one RTC during the past year. Targeted education and enforcement of existing traffic laws may reduce the RTCs frequency in this relatively young population. Future studies may look at impact of such interventions.
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Affiliation(s)
- Eisa Aldhafeeri
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Farah Alshammari
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Hana Jafar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Haya Malhas
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Marina Botras
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Noor Alnasrallah
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait
| | - Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait.
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Sundelin HEK, Chang Z, Larsson H, Lichtenstein P, Almqvist C, Tomson T, Ludvigsson JF. Epilepsy, antiepileptic drugs, and serious transport accidents: A nationwide cohort study. Neurology 2018; 90:e1111-e1118. [PMID: 29490912 DOI: 10.1212/wnl.0000000000005210] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the association between epilepsy and antiepileptic drugs and serious transport accidents requiring emergency care or resulting in death. METHODS We identified 29,220 individuals 18 years or older with epilepsy without cerebral palsy or intellectual disability and 267,637 matched controls using Swedish registers. This nationwide cohort was followed from 2006 to 2013 for serious transport accidents. We used Cox regression to analyze the risk of serious transport accidents between individuals with epilepsy and matched controls, and then stratified Cox regression to compare the risk during periods of medication with the risk during nonmedication period within the same individual with epilepsy. We adjusted for civil status, employment, education, living area, psychiatric disorders prior to the start of follow-up, and psychotropic medication. RESULTS Compared to matched controls, individuals with epilepsy were at increased risk of serious transport accidents (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.29-1.46). There were increased risks of pedestrian accidents (HR 2.24, 95% CI 1.69-2.97), bicycle accidents (HR 1.68, 95% CI 1.49-1.89) and car accidents (HR 1.31, 95% CI 1.19-1.44). However, among patients with a diagnosis of epilepsy, use of antiepileptic drugs did not influence the risk of serious transport accidents in population-level comparisons (HR 0.97; 95% CI 0.85-1.11) or within-individual comparisons (HR 0.99; 95% CI 0.69-1.42). CONCLUSION Serious transportation accidents were more common in individuals with epilepsy, but this risk was independent of use of antiepileptic drugs.
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Affiliation(s)
- Heléne E K Sundelin
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY.
| | - Zheng Chang
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Henrik Larsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Paul Lichtenstein
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Catarina Almqvist
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Torbjörn Tomson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Jonas F Ludvigsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
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Jitkritsadakul O, Bhidayasiri R. Physicians' role in the determination of fitness to drive in patients with Parkinson's disease: systematic review of the assessment tools and a call for national guidelines. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:14. [PMID: 27729986 PMCID: PMC5048693 DOI: 10.1186/s40734-016-0043-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area. OBJECTIVES AND METHODS To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations. RESULTS Of 1,490 abstracts screened, 55 articles fulfilled the selection criteria that investigated assessment of driving ability in PD patients with questionnaires, off-road testing battery, driving simulators, and driving skill tests (on-road tests and naturalistic driving test). Despite different methodology across studies, PD patients were observed to commit more driving errors than controls. Poor driving performance correlated with motor, visual, and cognitive severity. Excessive daytime somnolence was common in PD drivers and the presence of falling asleep while driving was identified to be a significant predictor of car accidents. CONCLUSION Although the evidence indicated more driving errors among PD drivers as identified by various assessment tools, the extent on how physicians should be involved in the evaluation process and make related recommendations remain unclear. Driving safety is an important public health issue in PD that needs better-defined specific legal and medical guidelines. National guidelines that establish risk assessment protocols involving multidisciplinary assessments are needed to assist physicians in making appropriate referrals for additional evaluations and recommendations when patients are deemed to be unsafe drivers.
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Affiliation(s)
- Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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Capovilla G, Kaufman KR, Perucca E, Moshé SL, Arida RM. Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy. Epilepsia 2015; 57:6-12. [PMID: 26662920 DOI: 10.1111/epi.13261] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
People with epilepsy (PWEs) are often advised against participating in sports and exercise, mostly because of fear, overprotection, and ignorance about the specific benefits and risks associated with such activities. Available evidence suggests that physical exercise and active participation in sports may favorably affect seizure control, in addition to producing broader health and psychosocial benefits. This consensus paper prepared by the International League Against Epilepsy (ILAE) Task Force on Sports and Epilepsy offers general guidance concerning participation of PWEs in sport activities, and provides suggestions on the issuance of medical fitness certificates related to involvement in different sports. Sports are divided into three categories based on potential risk of injury or death should a seizure occur: group 1, sports with no significant additional risk; group 2, sports with moderate risk to PWEs, but no risk to bystanders; and group 3, sports with major risk. Factors to be considered when advising whether a PWE can participate in specific activities include the type of sport, the probability of a seizure occurring, the type and severity of the seizures, seizure precipitating factors, the usual timing of seizure occurrence, and the person's attitude in accepting some level of risk. The Task Force on Sports and Epilepsy considers this document as a work in progress to be updated as additional data become available.
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Affiliation(s)
- Giuseppe Capovilla
- Child Neuropsychiatry Department, Epilepsy Center, C. Poma Hospital, Mantova, Italy
| | - Kenneth R Kaufman
- Departments of Psychiatry, Neurology and Anesthesiology, Rutgers - Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia and C. Mondino National Neurological Institute, Pavia, Italy
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience and Department of Pediatrics, Laboratory of Developmental Epilepsy, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, U.S.A
| | - Ricardo M Arida
- Department of Physiology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Brown JWL, Lawn ND, Lee J, Dunne JW. When is it safe to return to driving following first-ever seizure? J Neurol Neurosurg Psychiatry 2015; 86:60-4. [PMID: 24769470 DOI: 10.1136/jnnp-2013-307529] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The risk of recurrence following a first-ever seizure is 40-50%, warranting driving restriction during the early period of highest risk. This restriction must be balanced against the occupational, educational and social limitations that result from patients being ineligible to drive. The recommended duration of non-driving after a first seizure varies widely between jurisdictions, influenced by various factors including the community perception of an acceptable relative level of risk for an accident (the accident risk ratio; ARR). Driving restrictions may be based on individualised risk assessments or across-the-board guidelines, but these approaches both require accurate data on the risk of seizure recurrence. METHODS 1386 patients with first-ever seizure were prospectively analysed. Seizure recurrence was evaluated using survival analysis. The duration of non-driving required for a range of risks of seizure recurrence and ARRs was calculated. Additionally, the actual occurrence of seizures while driving was prospectively determined during follow-up. RESULTS For a risk of seizure recurrence to fall to 2.5% per month, corresponding to a monthly risk of a seizure while driving of 1.04 per thousand and an ARR of 2.6, non-driving periods of 8 months are required for unprovoked first-ever seizure, and 5 months for provoked first-ever seizure. Of patients with a seizure recurrence, 14 (2%) occurred while driving, with the monthly risk falling to less than 1/1000 after 6 months. CONCLUSIONS Our data provide a quantitative approach to decisions regarding a return to driving in patients with first-ever provoked or unprovoked seizure.
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Affiliation(s)
- J W L Brown
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - N D Lawn
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Lee
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J W Dunne
- Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
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Hafner J, Horn S, Robinson M, Purdie G, Jannes J. Impact of New Regulations On Assessing Driving Status (INROADS): A South Australian seizure clinic cohort. J Clin Neurosci 2014; 21:1920-3. [DOI: 10.1016/j.jocn.2014.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/13/2014] [Accepted: 03/25/2014] [Indexed: 11/24/2022]
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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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Looking back: Progress in epilepsy reflected in the Editor's Choice papers published in Seizure in 2012. Seizure 2013; 22:1-2. [DOI: 10.1016/j.seizure.2012.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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