Epilepsy and driving: Potential impact of transient impaired consciousness

Chen, William; Chen, Eric; Gebre, Rahiwa Z.; Johnson, M. H.; Li, Ningcheng; Vitkovskiy, Petr; Blumenfeld, Hal

doi:10.1016/j.yebeh.2013.09.024

Cited by 39 publications

(28 citation statements)

References 63 publications

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“…4–8 Seizures occur commonly among patients with supratentorial meningiomas, both pre- and postoperatively. 9 Recurrent seizures negatively impact patient quality of life, 10 affecting ability to drive, 11 employment, and independence, and can lead to significant comorbidities. 10,12–14 As such, seizure freedom represents an important outcome measure following meningioma resection, and one that has been relatively understudied.…”

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confidence: 99%

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

et al. 2017

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BACKGROUND Risk factors for pre- and postoperative seizures in supratentorial meningiomas are understudied compared to other brain tumors. OBJECTIVE To report seizure frequency and identify factors associated with pre- and postoperative seizures in a large single-center population study of patients undergoing resection of supratentorial meningioma. METHODS Retrospective chart review of 1033 subjects undergoing resection of supratentorial meningioma at the author’s institution (1991–2014). Multivariate regression was used to identify variables significantly associated with pre- and postoperative seizures. RESULTS Preoperative seizures occurred in 234 (22.7%) subjects. At 5 years postoperative, probability of seizure freedom was 89.9% among subjects without preoperative seizures and 62.2% with preoperative seizures. Multivariate analysis identified the following predictors of preoperative seizures: presence of ≥1 cm peritumoral edema (odds ratio [OR]: 4.45, 2.55–8.50), nonskull base tumor location (OR: 2.13, 1.26–3.67), greater age (OR per unit increase: 1.03, 1.01–1.05), while presenting symptom of headache (OR: 0.50, 0.29–0.84) or cranial nerve deficit (OR: 0.36, 0.17–0.71) decreased odds of preoperative seizures. Postoperative seizures after discharge were associated with preoperative seizures (OR: 5.70, 2.57–13.13), in-hospital seizure (OR: 4.31, 1.28–13.67), and among patients without preoperative seizure, occurrence of medical or surgical complications (OR 3.39, 1.09–9.48). Perioperative anti-epileptic drug use was not associated with decreased incidence of postoperative seizures. CONCLUSIONS Nonskull base supratentorial meningiomas with surrounding edema have the highest risk for preoperative seizure. Long-term follow-up showing persistent seizures in meningioma patients with preoperative seizures raises the possibility that these patients may benefit from electrocorticographic mapping of adjacent cortex and resection of noneloquent, epileptically active cortex.

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confidence: 99%

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

et al. 2017

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“…Many states in the United States may hold physicians liable for advice regarding driving that they provided to patients with seizures. [26][27][28] In the case of dementia, both the Clinical Dementia Rating Scale and the Mini-Mental State Examination (score less than or equal to 24) were useful in predicting the risk of motor vehicle accidents in patients with dementia, as was a caregiver's rating that a patient was unsafe to drive. Risk factors for accidents in this group of patients includes history of citations and crashes, situational driving avoidance, history of driving less than 60 miles per week, and increased aggression and impulsivity.…”

Section: Driving Risk Discussion and Referralmentioning

confidence: 99%

Quality improvement in neurology

Martello¹,

Buchhalter²,

Das³

et al. 2019

Neurology

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The American Academy of Neurology (AAN) formed a work group to evaluate quality measures applicable to a general neurologist. Currently available general measurement options-such as smoking, immunization, and weight-although relevant to a wide patient population, do not, for the most part, reflect the practice of neurology. Rather than developing quality measures specific to one neurologic subspecialty, the goal of this project was to develop quality measures that are universally applicable to neurology. Quality measures use clinical practice guideline recommendation statements and research to generate a measurable action a provider may perform. Quality measures do not generate new evidence or recommendations. Quality measures are one way that guideline recommendations are operationalized for use in clinical practice. Eight quality measure groups were determined to have relevance across the practice of neurology. Falls outcome and plan of care Falls are a leading cause of death in persons aged 65 years and older. 1 In addition, multiple neurologic conditions increase the risk of falling in younger persons. In persons who do fall and who require hospitalization, the cost is approximately $39,000 per patient. 2 This quality measure addresses the percentage of patients who reported a fall during the measurement and who had a plan of care documented. Activity counseling for back pain Back pain is a frequent cause of sick days for those in the workforce and a frequent complaint in neurologic practice. 3 In 1990, it was reported that low back pain was the fifth most common reason to see a physician. 4 A 2002 National Health Interview Survey indicated that one fourth of US adults reported back pain in the last 3-month period. 5 A 2006 socioeconomic study showed total costs attributable to low back pain in the United States were estimated at $100 billion, two-thirds of which were indirect costs of lost wages and productivity. 6 This quality measure addresses the percentage of adults between 18 and 65 years of age with back pain who were either counseled to remain active or referred to physical therapy. Maltreatment screening and action Maltreatment is a national priority. In children, maltreatment is associated with increased medical costs, approximating 9% of all Medicaid expenditures for children. 7 It is estimated that approximately 10% of older adults experience maltreatment or abuse. 8 Maltreatment of patients is reported at a higher frequency in patients with neurologic conditions that involve functional

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“…Conversely, proposed mitigating factors for PWE would be a previous history as a good driver and good adherence to treatment, and in persons with a first seizure, no recurrence after a follow-up period of at least six months with normal EEG and MRI (Kang and Mintzer, 2016). While GTCS are associated with a higher risk of severe injury in this setting, seizures of any type and duration of loss of awareness can have a variable impact on the ability to drive (Chen et al, 2014) and thus, a range of consequences. In theory, having a warning should allow PWE to pull off the road before an impending seizure, assuming motor function is not impaired at the initial stage of the seizure, however, whether auras in general make driving safer is still unclear (Xu et al, 2019).…”

Section: Traffic Accidents As a Cause Of Seizure-related Injury Or Deathmentioning

confidence: 99%

Living safely with epilepsy: a key learning review

Bertinat

Kerr

Cramer

et al. 2020

Epileptic Disorders

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This review focusses on counselling to reduce the risks of seizures in epilepsy patients. Risk reduction, whilst maximising the independence of persons with epilepsy, is a core element of epilepsy practice. The importance of the issue is reflected by the inclusion of risk assessment and reduction in the recent International League Against Epilepsy Curriculum for epileptology. This article addresses the key elements of epilepsy risk and provides practical guidance for counselling and risk reduction. A review of key publications was performed focusing on: (1) the risk of injury associated with seizures; (2) safety issues related to seizures and lifestyle; (3) SUDEP risk and avoidance; and (4) assessing individual risks. Risk is common in epilepsy and is multifactorial. Clinicians should be aware of the risk factors associated with different epilepsy features, such as seizure type, as well as those related to lifestyle and common indoor and outdoor activities. In addition, transcultural differences should be considered in risk assessment and counselling, e.g. regarding SUDEP or even driving, for which regulations vary across nations. Assessment of individual risk is evolving through a better understanding of risk factors and methodologies which can improve communication and empower patients to help identify and manage their individual risks.

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Epilepsy and driving: Potential impact of transient impaired consciousness

Cited by 39 publications

References 63 publications

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Quality improvement in neurology

Living safely with epilepsy: a key learning review

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