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

Pohlmann-Eden, B.; Hynick, Nina; Legg, Karen

doi:10.1017/s0317167100014633

Cited by 9 publications

(5 citation statements)

References 23 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A retrospective study performed in Canada looking at people who presented to a first-time seizure clinic over a 3-year period identified 158 people with newly diagnosed epilepsy, and found that 13 experienced a first seizure while driving, leading to seven accidents (4.4%) and one fatality. 25 Our study found a similar percentage of people with undiagnosed epilepsy who reported experiencing MVAs related to prior seizures (23 of 447, or 5%).…”

Section: Discussionsupporting

confidence: 70%

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

et al. 2020

View full text Add to dashboard Cite

Objective: To test the hypothesis that people with focal epilepsy experience diagnostic delays that may be associated with preventable morbidity, particularly when seizures have only nonmotor symptoms, we compared time to diagnosis, injuries, and motor vehicle accidents (MVAs) in people with focal nonmotor versus focal seizures with motor involvement at epilepsy onset. Methods: This retrospective study analyzed the enrollment data from the Human Epilepsy Project, which enrolled participants between 2012 and 2017 across 34 sites in the USA, Canada, Europe, and Australia, within 4 months of treatment for focal epilepsy. A total of 447 participants were grouped by initial seizure semiology (focal nonmotor or focal with motor involvement) to compare time to diagnosis and prediagnostic injuries including MVAs. Results: Demographic characteristics were similar between groups. There were 246 participants (55%) with nonmotor seizures and 201 participants (45%) with motor seizures at epilepsy onset. Median time to diagnosis from first seizure was 10 times longer in patients with nonmotor seizures compared to motor seizures at onset (P < .001). The number and severity of injuries were similar between groups. However, 82.6% of MVAs occurred in patients with undiagnosed nonmotor seizures. Significance: This study identifies reasons for delayed diagnosis and consequences of delay in patients with new onset focal epilepsy, highlighting a treatment gap that is particularly significant in patients who experience nonmotor seizures at epilepsy onset.

show abstract

Section: Discussionsupporting

confidence: 70%

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Other studies have examined the dangers of driving in people with known epilepsy or have looked at first lifetime seizures but have not analyzed the frequency and consequences of all prediagnostic SzWD. 11,12 In our study, 5% of participants reported experiencing SzWD before diagnosis, and several experienced multiple. By relying on self-reporting of historical events, this likely underestimates the true incidence and cannot account for mortality related to SzWD.…”

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Impact of Seizures While Driving Prior to Diagnosis in People With Focal Epilepsy

Bases,

Barnard,

French

et al. 2023

Neurology

View full text Add to dashboard Cite

Objective:To identify the type, frequency, and consequences of seizures while driving (SzWD) in people with epilepsy prior to diagnosisMethods:We performed a retrospective cohort study using the Human Epilepsy Project (HEP) to identify pre-diagnostic SzWD. Clinical descriptions from seizure diaries and medical records were used to classify seizure types and frequencies, time-to-diagnosis, and SzWD outcomes. Data was modeled using multiple logistic regression to assess for factors independently associated with SzWD.Results:32 pre-diagnostic SzWD were reported among 23/447 (5.1%) participants. Of these, seven (30.4%) had more than one. Six participants (26.1%) experienced a SzWD as their first-lifetime seizure. Most SzWD were focal with impaired awareness (n=27, 84.4%). Of participants who had MVAs, six (42.9%) had no recollection. SzWD led to hospitalization in 11 people. Median time from first seizure to first SzWD was 304 days (IQR=0-4056 days). Median time between first SzWD to diagnosis was 64 days (IQR=10-176.5 days). Employment was associated with a 3.95-fold increased risk of SzWD (95% CI: 1.2-13.2, p = 0.03), and non-motor seizures were associated with a 4.79-fold increased risk (95% CI: 1.3-17.6, p = 0.02).Significance and Discussion:This study identifies the consequences of seizure-related MVAs and hospitalizations people experience prior to epilepsy diagnosis, . This highlights the need for further research aimed at improving seizure awareness and improving time to diagnosis.

show abstract

“…Major injuries may not be a common feature given the nonconvulsive nature of most prior seizures, 4,28 although their association with injuries is probably largely missed. Particularly concerning is the risk for activities with little margin for error, such as driving, 4,28,58 swimming, cooking, work with a ladder or heavy machinery, and childcare. Patients who were not prescribed AEDs after a diagnosis of epilepsy were found to have increased injuries (burns, falls, fractures, MVAs) and suicidality compared to those prescribed AEDs, suggesting untreated seizures have some risk of injury.…”

Section: Discussionmentioning

confidence: 99%

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy

2021

View full text Add to dashboard Cite

A substantial proportion of individuals with newly diagnosed epilepsy report prior seizures, suggesting a missed opportunity for early epilepsy care and management.Consideration of the causes and outcomes of diagnostic delay is needed to address this issue. We aimed to review the literature pertaining to delay to diagnosis of epilepsy, describing the components, characteristics, and risk factors for delay. We undertook a systematic search of the literature for full-length original research papers with a focus on diagnostic delay or seizures before diagnosis, published 1998-2020.Findings were collated, and a narrative review was undertaken. Seventeen papers met the inclusion criteria. Studies utilized two measures of diagnostic delay: seizures before diagnosis and/or a study-defined time between first seizure and presentation/ diagnosis. The proportion of patients with diagnostic delay ranged from 16% to 77%; 75% of studies reported 38% or more to be affected. Delays of 1 year or more were reported in 13%-16% of patients. Seizures prior to diagnosis were predominantly nonconvulsive, and usually more than one seizure was reported. Prior seizures were often missed or mistaken for symptoms of other conditions. Key delays in the progression to specialist review and diagnosis were (1) "decision delay" (the patient's decision to seek/not seek medical review), (2) "referral delay" (delay by primary care/ emergency physician referring to specialist), and (3) "attendance delay" (delay in attending specialist review). There were few data available relevant to risk factors and virtually none relevant to outcomes of diagnostic delay. This review found that diagnostic delay consists of several components, and progression to diagnosis can stall at several points. There is limited information relating to most aspects of delay apart from prevalence and seizure types. Risk factors and outcomes may differ according to delay characteristics and for each of the key delays, and recommendations for future research include examining each before consideration of interventions is made.

show abstract

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

Cited by 9 publications

References 23 publications

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy

Impact of Seizures While Driving Prior to Diagnosis in People With Focal Epilepsy

Missed, mistaken, stalled: Identifying components of delay to diagnosis in epilepsy

Contact Info

Product

Resources

About