Driving after epilepsy surgery: effects of visual field defects and epilepsy control

Abstract

The aim of this study was to assess the eligibility to drive in patients with mesial temporal sclerosis who undergo anterior temporal lobectomy. The two major determinants in a patient's ability to drive after such surgery are visual field defects and their seizure frequency. Thirteen patients were selected. The postoperative seizure frequency was assessed using Engel's criteria. Automated static perimetry was performed which consisted of a Humphrey Field Analyser (HFA) 30-2 Test, one for each eye and a Binocular Esterman 120 Test. Seven out of the 13 (54%) selected patients had no seizures post-operatively (Engel's 1); three (23%) patients had less than two seizures per year (Engel's 2) and three (23%) had more than 90% improvement in the frequency of seizures (Engel's 3). The seven patients with no seizures postoperatively were eligible to apply for a driving licence. Automated static perimetry performed on the same patients revealed three (23%) had normal visual field or non-specific loss, seven (54%) had partial homonymous quadrantanopia, one (8%) had complete homonymous quadrantanopia and two (15%) had bilateral concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of the 13 patients, only seven (54%) passed the standardised DVLA Esterman visual field test. Of the six (46%) who failed DVLA Esterman visual field test, one had complete homonymous quadrantanopia, three had incomplete homonymous quadrantanopia and two had concentric loss (due to vigabatrin). Although seven (54%) patients passed the visual field test and seven (54%) patients were seizure free only five of the seven seizure-free patients (i.e. 38% of the total number of patients) had visual fields that would make them eligible to drive. As driving is now stated by patients' as a major factor that improves their quality of life, it is important to stress the significance of surgically induced or other iatrogenic visual field defects that may prevent them from driving prior to the operation to avoid disappointments afterwards.

Susceptibility-Weighted Imaging at 3 Tesla Delineates the Optic Radiation

“…6,12,34,[43][44][45] Some opinions consider this complication as clinically tolerable, because the central bundle of the OR representing the macula is saved and visual acuity may thus be maintained, although preservation of visual function will be desired, particularly for patients with benign pathology including epilepsy but otherwise healthy and with long life expectancy. 46 Accurate localization of this fiber bundle could thus prove beneficial for such patients.…”

Visual field deficits following anterior temporal lobectomy: Long‐term follow‐up and prognostic implications

“…In some jurisdictions, patients can have their driver’s licenses denied or suspended even if they do not functionally appreciate their VFDs. For example, in the United Kingdom, a driver’s license can still be denied or suspended in as high as 25% of patients if they have a sufficiently “severe” defect as deemed by their doctor upon visual field testing (Manji, 2000; Ray et al., 2002). In Ontario, Canada, patients who have a VFDs >90° from the vertical meridian (more than a superior quadrant defect) have a much higher risk of losing their licenses, as they end up with a horizontal visual field of <120°.…”

Fahreignung bei zerebralen Sehstörungen

“…Ray u. Mitarbeiter [9] untersuchten bei 13 Patienten die Gesichtsfelder, bei denen ein epilepsiechirurgischer Eingriff am mesialen Temporallappen durchgeführt worden war. Davon wiesen 10 Patienten Ausfälle unterschiedlicher Größe auf, typischerweise im kontralateralen oberen Quadranten, z. T. aber auch auf den unteren Quadranten übergreifend.…”

“…Zahl der Reize und die damit auch deutlich verlängerte Untersuchungszeit führen zwangsläufig zur Ermüdung des Patienten und damit zu einer Vielzahl von Fehlern. Die meisten statischen Perimetrien beschränkten sich deshalb auf die Abtastung eines Gesichtsfeldbereiches von 30 Grad Radius [9]. Seltener werden Programme verwendet, die auch jenseits 30 Grad oder gar jenseits 60 Grad messen.…”