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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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Xu Y, Hackett ML, Glozier N, Nikpour A, Somerville E, Bleasel A, Ireland C, Anderson CS. Return to driving after a diagnosis of epilepsy: A prospective registry study. Epilepsia 2018; 59:661-667. [DOI: 10.1111/epi.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ying Xu
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
| | - Maree L. Hackett
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Faculty of Health and Wellbeing University of Central Lancashire Preston UK
| | - Nick Glozier
- Brain and Mind Centre University of Sydney Camperdown New South Wales Australia
| | - Armin Nikpour
- Neurology Department Sydney Local Area Health District Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Ernest Somerville
- Neurology Department Prince of Wales Clinical School University of New South Wales Randwick New South Wales Australia
| | - Andrew Bleasel
- Neurology Department Westmead Hospital Westmead New South Wales Australia
| | - Carol Ireland
- Epilepsy Action Australia Epping New South Wales Australia
| | - Craig S. Anderson
- The George Institute for Global Health Faculty of Medicine University of New South Wales Camperdown New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Neurology Department Sydney Local Area Health District Royal Prince Alfred Hospital Camperdown New South Wales Australia
- The George Institute for Global Health Peking University Health Science Center Beijing China
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Abstract
Abstract:Background:Seizures while driving are a well known occurrence in established epilepsy and have significant impact on driving privileges. There is no data available on patients who experience their first (diagnosed) seizure while driving (FSWD).Method:Out of 311 patients presenting to the Halifax First Seizure Clinic between 2008 and 2011, 158 patients met the criteria of a first seizure (FS) or drug-naïve, newly diagnosed epilepsy (NDE). A retrospective chart review was conducted. FSWD was evaluated for 1) prevalence, 2) clinical presentation, 3) coping strategies, and 4) length of time driving before seizure occurrence.Results:The prevalence of FSWD was 8.2%. All 13 patients experienced impaired consciousness. Eleven patients had generalized tonic-clonic seizures, one starting with a déjà-vu evolving to visual aura and a complex partial seizure; three directly from visual auras. Two patients had complex partial seizures, one starting with an autonomic seizure. In response to their seizure, patients reported they were i) able to actively stop the car (n=4, three had visual auras), ii) not able to stop the car resulting in accident (n=7), or iii) passenger was able to pull the car over (n=2). One accident was fatal to the other party. Twelve out of 13 patients had been driving for less than one hour.Discussion:FSWD is frequent and possibly underrecognized. FSWD often lead to accidents, which occur less if preceded by simple partial seizures. Pathophysiological mechanisms remain uncertain; it is still speculative if complex visuo-motor tasks required while driving play a role in this scenario.
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