A decision tree to determine fitness to drive in epilepsy: Results of a pilot in two Australian states

The regulation of driving with non-epileptic seizures must be made clearer

Patients with epilepsy have their authorisation to drive restricted under detailed guidelines, but the rules for those with non-epileptic seizures are far less clear. We surveyed specialist clinicians in Australia and found little agreement as to whether such guidelines existed for non-epileptic seizures or what they might be. A number of possible interpretations of the Australian fitness to drive guidelines are explored, and these are often vague in themselves, as well as uncertain in their scope. This means clinicians making momentous driving decisions for their patients with non-epileptic seizures are doubly challenged, first in interpreting what guidelines exist, and second in what they mean. The International League Against Epilepsy proposed specific guidelines for driving with non-epileptic seizures, which reflect the range of presentations of non-epileptic seizures in a decision-making algorithm. We believe a specific algorithm such as this is essential in removing one level of uncertainty and responsibility for clinicians, and restoring equity for patients with non-epileptic seizures.

Artificial neural network and decision tree models of post-stroke depression at 3 months after stroke in patients with BMI ≥ 24

OBJECTIVE

Previous studies have shown that excess weight (including obesity and overweight) can increase the risk of cardiovascular, cerebrovascular and other diseases, but there is no study on the incidence of post-stroke depression (PSD) and related factors in patients with excessive weight. The main purpose of this study was to find related factors of PSD at 3 months after stroke in patients with excessive weight and construct artificial neural network (ANN) and decision tree (DT) models.

METHODS

This is a prospective multicenter cohort study (Registration number: ChiCTR-ROC-17013993). Five hundred and three stroke patients with Body Mass Index(BMI) ≥ 24 were included in this study. The diagnostic criteria of PSD is according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) diagnostic criteria for depression due to other medical conditions and the HAMD-17 scores > 7 at 3 months after stroke was used as the primary endpoint. The χ² test, Mann-Whitney U test or t-test were used to check for statistical significance.

RESULTS

Our study found that sleeping time < 5 h, CHD, physical exercise, BI score, N dimension(EPQ) and subjective support(SSRS) were associated with PSD in patients with excessive weight. Physical exercise(odd ratio [OR] = 0.49, p = 0.001, 95%CI [confidence interval]: 0.32-0.75) and BI score(OR = 0.99, p < 0.001, 95%CI: 0.98-0.99) were protective factors; sleeping time < 5 h(OR = 2.86, p < 0.001, 95%CI: 1.62-5.04), CHD(OR = 2.18, p = 0.018, 95%CI: 1.14-4.15), N dimension(OR = 1.08, p = 0.001, 95%CI: 1.03-1.13) and subjective support(OR = 1.04, p = 0.022, 95%CI: 1.01-1.07) were risk factors.

CONCLUSION

This study found several factors related to the occurrence of PSD at 3 months in patients with excessive weight. Meanwhile, ANN and DT models were constructed for clinicians to use.

Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation

The human, as a biological system, is an open system embedded within larger systems -including the family, culture, and socio-political environment. In this context, a patient with functional seizures (FS) is embedded in relationships, educational/professional institutions, culture, and society. Both connection to these broader systems and the quality of these connections, as well as the soundness of each system in and of itself, influence the health and well-being of patients in positive or negative ways. The social aspects of life are important determinants of health and quality of life across the lifespan. The current narrative review brings out several overarching themes in patients with FS. Sections on attachment, marriage, social networking, and stigma highlight the central roles of supportive and affirmative relationships across the lifespan. The section on education underscores the importance of keeping children and youth with FS connected within their school environments, as well as managing any barriers - learning difficulties, school response to FS events, stigma, etc.-that can diminish this connection. Finally, the sections on employment and driving highlight the value of being an active participant in one's society. In summary, FS impacts patients across most social aspects of life domains regardless of age - factors that are important when developing biopsychosocial formulations. This review concludes that the multidisciplinary management of FS requires careful assessment of social aspects of life in patients which can then be targeted for treatment, to improve their quality of life, facilitating recovery, and reducing the risk of relapse.

Driving in patients with psychogenic nonepileptic seizures

PURPOSE

We investigated the rate of driving in patients with psychogenic nonepileptic seizures (PNES) from a large cohort in Iran. We hypothesized that these patients commonly do not drive. We also investigated the potential factors that may be associated with driving in these patients.

METHODS

In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were investigated. Age, gender, age at seizure onset, seizure semiology and characteristics, driving history reported by the patients, and video-electroencephalography recordings of all patients were registered routinely.

RESULTS

During the study period, 221 patients with PNES only had the inclusion criteria and were studied. Forty-eight patients (21.7%) reported that they were driving a car in their routine daily lives. Male sex (odds ratio: 13.2; 95% confidence interval: 4.98-35.45; p = 0.0001) and being employed (odds ratio: 8.08; 95% confidence interval: 3.16-20.69; p = 0.0001) were independently significantly associated with driving.

CONCLUSION

We observed that only about one-fifth of adult patients with PNES reported driving. It is important for the scientific community to develop practice guidelines on how to counsel patients and also the related authorities (e.g., department of motor vehicle authorities) on driving restrictions in people who are affected with PNES.

Job consultation in patients with psychogenic nonepileptic seizures: Systematic review and survey of physicians' opinion

OBJECTIVES

The objectives of this study were 1) to review the literature about "job/employment and psychogenic nonepileptic seizures (PNES)" and 2) to gather the views of neurologists and psychiatrists on the issue of job consultation in patients with PNES.

METHODS

Phase one involved a systematic literature review; phase two involved the collection of the views of neurologists and psychiatrists, practicing in Fars province, Iran, on the issue of job consultation in patients with PNES. A questionnaire was designed for the purpose of this study.

RESULTS

No studies were identified by the systematic review process on the issue of job consultation in patients with PNES. Of the 87 health-care professionals approached, 63 responded to the survey (response rate: 72%). Respondents included 31 neurologists and 32 psychiatrists. In response to the question "Should all patients with PNES be counseled to pursue any job or profession they would like?", 17 (55%) neurologists and 19 (59%) psychiatrists answered "no" (p = 0.8).

CONCLUSION

While it is possible that some patients with PNES are more likely than other people in the general public to be involved in job-related difficulties (performing duties related to any job, accidents, etc.), there is currently no evidence supporting or refuting this proposition. However, in this study, the majority of the health-care professionals, who often deal with these patients, believed that not all patients with PNES should be counseled to pursue any job or profession they would like (i.e., there should be some restrictions).