Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-05T06:53:16.276Z Has data issue: false hasContentIssue false
  • English
  • Français

First Seizure While Driving (FSWD) — An Underestimated Phenomenon?

Published online by Cambridge University Press:  23 September 2014

Bernd Pohlmann-Eden ,
Nina Hynick  and
Karen Legg
Bernd Pohlmann-Eden*
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
Nina Hynick
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
Karen Legg
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
*
Division of Neurology, Room No 3838 Halifax Infirmary, Dalhousie University, 1796 Summer St, Halifax, Nova Scotia, B3H 3A7, Canada. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Résumé:

Résumé: Contexte:

Les crises convulsives survenant lors de la conduite d'un véhicule automobile sont un phénomène bien établi dans l'épilepsie et ont un impact significatif sur le permis de conduire. Il n'y a pas de données sur les patients qui ont leur première crise convulsive (diagnostiquée) en conduisant (PCCC).

Méthode:

Parmi les 311 patients examinés à la clinique de consultation pour une première crise convulsive à Halifax entre 2008 et 2011, 158 patients rencontraient les critères d'une première crise convulsive ou d'une épilepsie nouvellement diagnostiquée alors que le patient était sans traitement. Nous avons effectué une revue rétrospective de ces dossiers. Nous avons évalué la prévalence de la PCCC, sa présentation clinique, les stratégies d'adaptation et depuis combien de temps le patient conduisait avant que la crise convulsive ne survienne.

Résultats:

La prévalence de la PCCC était de 8,2%. Treize patients ont présenté une altération de l'état de conscience. Onze patients ont présenté une crise tonico-clonique généralisée, une crise ayant débuté par un déjà-vu évoluant en aura visuel et une crise partielle complexe, et chez 3 patients elle a été précédée directement d'auras visuels. Deux patients ont eu des crises partielles complexes dont l'une a débuté par une crise d'épilepsie autonome. En réponse à leur crise, les patients ont rapporté soit qu'ils avaient été capables d'arrêter l'automobile (n = 4, trois avec aura visuel), qu'ils n'ont pas été capables d'arrêter l'automobile ce qui a provoqué un accident (n = 7), ou que le passager a été capable d'arrêter l'automobile en bordure de la route (n = 2). Un accident a causé la mort d'occupants dans le véhicule qui a été heurté. Douze des 13 patients conduisaient depuis moins d'une heure au moment de la crise.

Discussion:

Une PCCC est un phénomène fréquent et potentiellement sous-diagnostiqué. Une PCCC est souvent la cause d'accidents, moins fréquemment si elle est précédée par une crise d'épilepsie partielle simple. Ses mécanismes physiopathologiques demeurent obscurs et et nous ne savons pas si les tâches visuo-motrices complexes exigées pour la conduite automobile y contribuent.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 4 , July 2013 , pp. 540 - 545
Copyright
Copyright © The Canadian Journal of Neurological 2013

References

1. CCMTA.ca. CCMTA medical standards for drivers. [pdf on the Internet]. Ottawa: Canadian Council of Motor Transport Administrators. [2012 Aug 30]. Available from: http://www.ccmta.ca/english/pdf/medical_standards_aug_2011.pdf. Google Scholar
2. cma.ca. Determining medical fitness to operate motor vehicles: CMA drivers guide (7th edition)[book on the Internet]. Ottawa: Can Med Assn; c 18223 [2006]. Available from: http://www.cma.ca/index.php/ci_id/18223/la_id/1.htm. Google Scholar
3. McGwin, G. Relationship of CVD and car accidents. Can Fam Physician. 1998;44:2061–2.Google ScholarPubMed
4. Skurtveit, S, Strom, H, Skrivarhaug, T, Morland, J, Bramness, JG, Engeland, A. Road traffic accident risk in patients with diabetes mellitus receiving blood glucose-lowering drugs. Prospective follow-up. Diabetic Med. 2009;26:404–8.CrossRefGoogle ScholarPubMed
5. Lonnen, KF, Powell, RJ, Taylor, D, Shore, AC, MacLeod, KM. Road traffic accidents and diabetes: insulin use does not determine risk. Diabetic Med. 2008;25:578–84.Google Scholar
6. Thaelwitzer, F. Epileptiker als Autofahrer. Munch Med Wochenschrift. 1906;37:1818.Google Scholar
7. Warlow, C. Driving after a first seizure. [editorial]. BMJ [serial on the internet]. 2010 Dec [cited 2011 July 12];341:c6890. Available from: http://www.bmj.com/content. Google Scholar
8. Lund, M. Epilepsy and the driving license. Hexagone Roche. 1974;2:19–23.Google Scholar
9. Stollreiter, E. Aktuelle fragen der sozialen und beruflichen eingliederungen von epileptikern. Arzneimittelforschung. 1963;60:142.Google Scholar
10. Fisher, RS, Parsonage, M, Beaussart, M et al. Epilepsy and driving: an international perspective. Joint commission on drivers’ licensing of the international bureau for epilepsy and the international league against epilepsy. Epilepsia. 1994;35:675–84.Google Scholar
11. Pohlmann-Eden, BP, Beghi, E, Camfield, C, Camfield, P. The first seizure and its management in adults and children. BMJ. 2006;332(7537):339–42.CrossRefGoogle ScholarPubMed
12. Bonnett, LJ, Tudur-Smith, C, Williamson, PR, Marson, AG. Risk of recurrence after a first seizure and implications for driving: further analysis of the multicentre study of early epilepsy and single seizures. BMJ (Clin Research Ed). 2010;341:c6477.Google Scholar
13. Holland, P, Lane, S, Whitehead, M, Marson, AG, Jacoby, A. Labor market participation following onset of seizures and early epilepsy: findings from a UK cohort. Epilepsia. 2009;50(5): 1030–9.Google Scholar
14. Kamel, JT, Christensen, B, Odell, MS, D’Souza, WJ, Cook, MJ. Evaluating the use of prolonged video-EEG monitoring to assess future seizure risk and fitness to drive. Epilepsy Behav. 2010;19:608–11.CrossRefGoogle ScholarPubMed
15. Krauss, GL, Krumholz, A, Carter, RC, Li, G, Kaplan, P. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurol. 1999;52(7):1324–9.Google Scholar
16. Millett, CJ, Johnson, AL, Thompson, PJ, Fish, DR. A study of the relationship between participation in common leisure activities and seizure occurrence. Acta Neurol Scand. 2001;103:300–3.Google Scholar
17. Aldenkamp, AP, Arends, J, Verspeek, S, Berting, M. The cognitive impact of epileptiform EEG-discharges; relationship with type of cognitive task. Child Neuropsychol. 2004;10(4):297–305.Google Scholar
18. Matsuoko, H, Nakamura, M, Ohno, T, et al. The role of cognitive - motor function in precipitation and inhibition of epileptic seizures. Epilepsia. 2005;46 (Suppl 1):17–20.CrossRefGoogle Scholar
19. Helmstaedter, C, Hufnagel, A, Elger, CE. Seizures during cognitive testing in patients with temporal lobe epilepsy: possibility of seizure induction by cognitive activation. Epilepsia. 1992;33: 892–7.Google Scholar
20. Finucane, AK. Epilepsy, driving and the law. Am Fam Physician. 1999;59(1):199–200.Google Scholar
21. Tatum, WO, Worley, AV, Selencia, ML. Disobedience and driving in patients with epilepsy. Epilepsy Behav. January 2012;23(1):30–5.Google Scholar
22. Webster, NJ, Crawford, P, Thomas, FM. Who’s behind the wheel? Driving with medically intractable epilepsy. Am J Health Behav. 2011;35(4):485–95.Google Scholar
23. Yang, L, Morland, TB, Schmits, K, et al. A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games. Epilepsy Behav. 2010;18(3):238–46.Google Scholar
24. Zifkin, B, Andermann, F. Epilepsy with reflex seizures. In: Wyllie, E, editor. The Treatment of epilepsy: Principles & practice. 5th ed. Philadelphia, Pa: Kluwer & Lippincott; 2011. p. 305–31.Google Scholar
25. Seshia, SS, Young, GB, Zifkin, BG. Guidelines for visual-sensitive EEG testing. Can J Neurol Sci. 2008;35(2):133–9.Google Scholar
26. Binnie, CD, Findlay, J, Wilkins, AJ. Mechanisms of epileptogenesis in photosensitive epilepsy implied by the effects of moving patterns. Electrenceph Clin Neurophys. 1985;61:1–6.CrossRefGoogle ScholarPubMed
27. Wilkins, AJ, Binnie, CD, Darby, CE. Visually induced seizures. Prog Neurobiol. 1980;15:85–117.Google Scholar
28. Wilkins, AJ, Zifkin, B, Andermann, F, et al. Seizures induced by thinking. Ann Neurol. 1982;11:608–12.CrossRefGoogle ScholarPubMed
29. Wolf, P, Mayer, T, Reker, M. Reading epilepsy: report of five new cases and further considerations on pathophysiology. Seizure. 1998;7:271–9.Google Scholar
30. Aldenkamp, AP, Arends, J. Effects of epileptiform EEG discharges on cognitive function: Is the concept of “transient cognitive impairment” still valid? Epilepsy Behav. 2004;5(1):25–34.Google Scholar
31. Kasteleijn-Nolst Trenité, DG, Riemersma, JB, Binnie, CD, Smit, AM, Meinardi, H. The influence of subclinical epileptiform EEG discharges on driving behaviour. Electroencephalogr Clin Neurophysiol. 1987;67(2):167–70.Google Scholar
32. Pohlmann-Eden, B. Conceptual relevance of new-onset epilepsy. Epilepsia. 2011;52(suppl. 4):1S–6S.Google Scholar