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Tatum WO, Desai N, Feyissa A. Ambulatory EEG: Crossing the divide during a pandemic. Epilepsy Behav Rep 2021; 16:100500. [PMID: 34778740 PMCID: PMC8578031 DOI: 10.1016/j.ebr.2021.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic forced temporary closure of epilepsy monitoring units across the globe due to potential hospital-based contagion. As COVID-19 exposures and deaths continues to surge in the United States and around the world, other types of long-term EEG monitoring have risen to fill the gap and minimize hospital exposure. AEEG has high yield compared to standard EEG. Prolonged audio-visual video-EEG capability can record events and epileptiform activity with quality like inpatient video-EEG monitoring. Technological advances in AEEG using miniaturized hardware and wireless secure transmission have evolved to small portable devices that are perfect for people forced to stay at home during the pandemic. Application of seizure detection algorithms and Cloud-based storage with real-time access provides connectivity to AEEG interpreters during prolonged "shut-down". In this article we highlight the benefits of AEEG as an alternative to diagnostic inpatient VEM during the paradigm shift to mobile heath forced by the Coronavirus.
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Affiliation(s)
| | - Nimit Desai
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Ryan M, Walshe J, Booth R, O'Neill DJ. Perceptions and attitudes toward risk and personal responsibility in the context of medical fitness to drive. TRAFFIC INJURY PREVENTION 2020; 21:365-370. [PMID: 32421397 DOI: 10.1080/15389588.2020.1766684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
Objective: Although there is a considerable body of literature probing the knowledge and awareness of doctors of guidelines on medical fitness to drive, little is known of knowledge and awareness of such guidelines among the general public. We investigated awareness, perceptions and attitudes among a range of adults toward risk and personal responsibility in the context of medical fitness to drive.Methods: This quasi-experimental between groups study assessed response differences between healthcare (33%) and non-healthcare professionals. Five hundred and fourteen adults (f = 342) completed a 15-item online survey, which assessed their license status, direct and secondhand experience with key medical conditions, perceptions of risk, driving intentions if advised to stop driving by a doctor and beliefs about responsibility for ensuring driver fitness.Results: Most of the participants had a driver license. Although the majority (87%) had no first-hand experience with key medical conditions contained in the Irish medical fitness to drive guidelines, two-thirds knew someone with at least one of these conditions. No participant admitted to an alcohol or drug misuse/dependence problem. Alcohol misuse/dependence and fatigue/chronic sleep loss were perceived as the greatest crash risk for drivers and for vulnerable road users. Risk perceptions in general public and the medical professionals were similar for most conditions but where they differed, the medical professionals perceived lower risk. Most respondents indicated that they would cease driving immediately if advised by their doctor for temporary and long-term conditions. No effects of age, gender, experience with medical conditions or professional status were noted on perceived intentions to cease driving. Perceptions about who is responsible for ensuring people are fit to drive fell into two categories. Drivers were perceived as chiefly responsible where alcohol, non-prescription drugs, fatigue and age were factors and doctors were identified as responsible in cases of diabetes, epilepsy, stroke, heart conditions and physical disabilities.Conclusions: These results suggest that more needs to be done to raise awareness of the risks posed by medical and other factors that reduce driver capability and also about drivers' responsibility to ensure that they are fit to drive and thus improve road safety.
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Affiliation(s)
- Margaret Ryan
- Irish National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin 2, Ireland
| | - James Walshe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rory Booth
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Desmond J O'Neill
- Irish National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin 2, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin 2 and Irish National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin 2, Ireland
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Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures. Epilepsy Behav 2020; 102:106703. [PMID: 31786471 DOI: 10.1016/j.yebeh.2019.106703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures. METHODS A hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action. RESULTS In this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value < 0.001) were given to the course action, "the pharmacist could counsel/educate the patient on the dangers/risks of driving while experiencing breakthrough seizures, inform the patient to refrain from driving in this period, and make a shared decision with the patient to refrain from driving in this period and inform the state authorities". CONCLUSION This study demonstrates that the 8-step approach when combined with the AHP can be a handy method in facilitating decision-making while addressing and resolving ethical/legal/professional dilemmas in daily healthcare practice.
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Algahtani H, Shirah B, Algahtani R, Algahtani R. Epilepsy and driving: Local experience from Saudi Arabia. Epilepsy Behav 2019; 99:106401. [PMID: 31454705 DOI: 10.1016/j.yebeh.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The issue of epilepsy and driving has legal, social, and psychological implications. Many countries in the world restrict driving to people prone to epilepsy. There is no data from Saudi Arabia regarding the prevalence of driving among patients with epilepsy and their driving practices. In addition, to the best of our knowledge, there are no local laws or guidelines concerning driving for patients with epilepsy in Saudi Arabia. This study aimed to determine the prevalence of driving among male patients with epilepsy at King Abdulaziz Medical City in Jeddah, Saudi Arabia and determine the barriers and difficulties that they are suffering from especially when it comes to driving. METHODS This is a cross-sectional study that was conducted between July 2017 and June 2018 at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria of this study were male patients with epilepsy 18 years of age or above. The exclusion criteria were female patients at any age (since they were not allowed to drive at the time of the study) and male patients less than 18 years of age. This study utilized a self-made self-administered 25-item questionnaire. RESULTS A total of 182 surveys were distributed, and 164 individuals completed the survey (90.1% response rate). Most of the participants have a driving license (95.7%) and drive a car (98.8%). Almost all participants (99.4%) mentioned that nobody asked them whether they have epilepsy or not when issuing a driver's license. In addition, 94.5% were never told not to drive after the diagnosis of epilepsy. Regarding restrictions to driving, 98.7% reported that they drive at all times without any restrictions, and 92.7% reported that they drive both inside and outside the city. CONCLUSION This study showed that the number of male patients with epilepsy driving cars was extremely high, accounting for almost all the patients in this study, with most of them doing several wrong practices during driving. Other major issues include the lack of specific laws regulating driving for patients with epilepsy and no counseling from physicians about driving after the diagnosis of epilepsy. We recommend developing the Saudi driving regulations for patients with epilepsy, and this study is considered an urgent call for action for the formation of a local driving regulations taskforce. Health education about the risk of driving should be disseminated, especially for patients with uncontrolled epilepsy.
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Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raneem Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raghad Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Recent Medico-Legal Developments on the Issue of Epilepsy and Driver's License Requirements in the Italian and European Legislation. Behav Neurol 2019; 2019:7127956. [PMID: 31662804 PMCID: PMC6791238 DOI: 10.1155/2019/7127956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is a condition that comprises a group of neurological disorders characterized by seizures. Forms of epilepsy that produce abrupt bouts that cause lapses in consciousness may pose a major road safety problem for drivers who, while going through a seizure, could seriously harm themselves as well as others. A fundamental strategy for the purpose of reducing the risk of car accidents caused by epileptic drivers is constituted by prevention, in addition to adequate pharmacological therapies. In that respect, forensic medicine plays a pivotal role, since it deals with the set of requirements that must be met by those who have been diagnosed with epilepsy in order to get a driver's license, and with the obligation to signal such individuals to the national Driver and Vehicle Licensing Agency (in Italian: Motorizzazione Civile). In that regard, the Italian legislative framework is partly hazy in some respects, which the authors have set out to analyze herein, taking into account recently issued European norms. The aim of this paper was to better understand the current Italian legislation in the matter of epilepsy and driver's license requirements, especially regarding the medical criteria that must be met in order to obtain the driving license. The importance of those criteria is underlined by the fact that they directly influence (and are influenced by) the safety for the drivers and for the persons involved in car accidents. Thus, we can consider the issue not only strictly of medico-legal relevance but also from the standpoint of primary prevention. The analysis was conducted by reviewing the most recent documents of medico-legal relevance, in the light of European Union legislation. The authors have ultimately stressed the need for clearer and straightforward regulations, given that professional liability may arise whenever a driver's license is issued, in disregard of legal norms, to an individual who then causes a road accident.
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Tan M, Boston R, Cook MJ, D'Souza WJ. Risk factors for injury in a community-treated cohort of patients with epilepsy in Australia. Epilepsia 2019; 60:518-526. [PMID: 30720862 DOI: 10.1111/epi.14659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There remains a paucity of knowledge regarding specific epilepsy-related risk factors for accidents and injuries in people with epilepsy. Injury studies in people with epilepsy are overrepresented, with tertiary based populations that are prone to bias from severe disease. This study aims to assess the contribution of epilepsy-related risk factors to injuries in a community-based cohort. METHODS We performed a retrospective nested case-control study on patients recruited into the Tasmanian Epilepsy Register (TER) from July 1, 2001 to June 30, 2002. The TER is a community-based cohort of patients with epilepsy in Tasmania, Australia, recruited from the national prescription database and interviewed for epilepsy diagnosis, injuries, and risk factors using validated questionnaires with diagnosis made by an epilepsy specialist. The primary outcome measures were lifetime and recent 12-month injury. Multivariate logistic regression with multiple imputation modeling responder nondisclosure was performed, adjusting for age, gender, region, socioeconomic status, seizure frequency, and epilepsy duration. RESULTS A total of 819 patients with epilepsy were included in this study. Ten percent of patients experienced an injury in the preceding year. Before adjusting for seizure frequency, any seizure over the past 12 months was associated with recent injury (adjusted odds ratio [OR] = 7.90, 95% confidence interval [CI] = 4.17-14.96). Impaired awareness, cluster seizures, sleep-only seizures, and convulsive seizure were characteristics found to significantly influence injuries irrespective of seizure frequency. Although a warning appeared initially protective for recent injuries (OR = 0.39, 95% CI = 0.22-0.69), this was entirely explained by seizure frequency, with the effect becoming nonsignificant. SIGNIFICANCE Likely due to their unpredictable nature, seizures expose patients with epilepsy to a high risk of life-threatening injury. These findings emphasize the importance of seizure freedom for maximizing the safety of patients with epilepsy.
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Affiliation(s)
- Michael Tan
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ray Boston
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Mark J Cook
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
BACKGROUND: There is no consensus among medical experts as to whether patients with epilepsy (PWEs) should be permitted to drive. PWEs who have had uncontrolled seizures in the past year are at an increased risk of road traffic accidents, often leading to the destruction of property, injury, or death. Currently, there is no clear policy on whether PWEs can drive in Saudi Arabia. Existing policies attempt to balance the potentially harmful and beneficial aspects of the issue. The purpose of this study was to measure the prevalence of PWEs who are unfit to drive. MATERIALS AND METHODS: Data were collected by interviews, a structured validated questionnaire, and a review of the medical records of 140 PWEs, with a response rate of 84%. RESULTS: Fifty four percent of PWEs were found unfit to drive. Of the 118 participants, 17.7% did not drive and 97 (82.3%) drove. Of the 21 patients who did not drive, 14 (11.8% of the total sample) never drove and 7 (5.9% of the total sample) stopped driving because of epilepsy. Of the 104 patients who drove, 45 (43.2% of the total sample) had a history of seizures while they drove. These incidents had resulted in the involvement of 28 patients (26.9% of the total sample) in motor vehicle accidents and 17 (16.3% of the total sample) patients being admitted to the emergency room. CONCLUSION: Structured regulation and licensing procedures are necessary for PWEs to drive safely. Regulations in other countries demand that seizures be controlled for 1 year before epileptic patients are allowed unrestricted driving. Such regulations would improve road safety in Saudi Arabia.
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Affiliation(s)
- Esra' H Al Zaid
- Department of Family Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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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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Ma BB, Bloch J, Krumholz A, Hopp JL, Foreman PJ, Soderstrom CA, Scottino MA, Matsumoto M, Krauss GL. Regulating drivers with epilepsy in Maryland: Results of the application of a United States consensus guideline. Epilepsia 2017; 58:1389-1397. [DOI: 10.1111/epi.13804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Brandy B. Ma
- Department of Neurology; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - John Bloch
- Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Allan Krumholz
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland U.S.A
| | - Jennifer L. Hopp
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland U.S.A
| | - Perry J. Foreman
- Department of Neurology; Sinai Hospital of Baltimore; Baltimore Maryland U.S.A
| | - Carl A. Soderstrom
- Medical Advisory Board; Maryland Motor Vehicle Administration; Glen Burnie Maryland U.S.A
| | - Mary A. Scottino
- Medical Advisory Board; Maryland Motor Vehicle Administration; Glen Burnie Maryland U.S.A
| | - Martha Matsumoto
- University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Gregory L. Krauss
- Department of Neurology; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
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Fountain NB, Van Ness PC, Bennett A, Absher J, Patel AD, Sheth KN, Gloss DS, Morita DA, Stecker M. Quality improvement in neurology: Epilepsy Update Quality Measurement Set. Neurology 2015; 84:1483-7. [PMID: 25846995 DOI: 10.1212/wnl.0000000000001448] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathan B Fountain
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Paul C Van Ness
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Amy Bennett
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - John Absher
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Anup D Patel
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Kevin N Sheth
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - David S Gloss
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Diego A Morita
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
| | - Mona Stecker
- From the Neurology Department (N.B.F.), Comprehensive Epilepsy Program, University of Virginia, Charlottesville; the Department of Neurology and Neurotherapeutics (P.C.V.N.), University of Texas Southwestern Medical Center, Dallas; the American Academy of Neurology (A.B.), Minneapolis, MN; Absher Neurology (J.A.), Greenville, SC; the Division of Neurology and Pediatrics (A.D.P.), Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus; the Division of Neurocritical Care & Emergency Neurology, Department of Neurology (K.N.S.), Yale University School of Medicine, New Haven, CT; the Department of Neurology (D.S.G.), Geisinger Health System, Danville, PA; the Department of Pediatrics, Division of Neurology (D.A.M.), Cincinnati Children's Hospital Medical Center, OH; and the Department of Patient Safety, Quality and Innovation (M.S.), Winthrop University Hospital, Mineola, NY
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Disobedience and driving in patients with epilepsy in Greece. Epilepsy Behav 2014; 41:179-82. [PMID: 25461212 DOI: 10.1016/j.yebeh.2014.09.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/20/2014] [Accepted: 09/28/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Regulations and guidelines regarding driving privileges of patients with epilepsy vary greatly worldwide. The aim of our study was twofold: firstly, to evaluate disobedient drivers in Greece and to elucidate their awareness of the law, emotional responses, and seizure profile and, secondly, to identify determinants of disobedience regarding driving among patients with epilepsy. METHODS All consecutive patients with epilepsy who visited the epilepsy outpatient clinic of two tertiary epilepsy centers were invited to participate in the study. One hundred ninety patients met our inclusion criteria. RESULTS Fifty-two percent of our study population was aware of the driving restrictions. More than one out of three patients were disobedient (35.8%). Being a male was associated with a 6.07-fold increase in the odds of being disobedient (95% CI: 2.73-13.47, p < 0.001); being employed was associated with a 4.62-fold increase in the odds of being disobedient (95% CI: 2.20-9.68, p < 0.001); and each extra antiepileptic drug (AED) was associated with a decrease in the odds of disobedience by a factor of 0.41 (95% CI: 0.26-0.63, p < 0.001). CONCLUSION Male gender, employment, and number of AEDs are important determinants of disobedience regarding driving among patients with epilepsy.
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12
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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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13
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Pinchi V, Norelli GA, Bartolini V. Ethical implications of Italian legislation on 'epilepsy and driving'. JOURNAL OF MEDICAL ETHICS 2014; 40:552-557. [PMID: 23900293 DOI: 10.1136/medethics-2012-100863] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The laws concerning driving licences and epilepsy in different countries are very diverse with regard to the criteria for issuance or renewal of licences, and also the methods of evaluating fitness. In 2011, a law was issued in Italy implementing the European directives on driving licences, including provisions for mandatory notification that a driver is epileptic. This was established regardless of the European rules that require compulsory notification only of patients. The Federation of Italian Boards of Physicians has made recommendations against mandated physician reporting, resulting in a current confusion between legal and ethical recommendations to medical doctors. The mandatory notification enacted by Italian law raises ethical concerns about disparities in access to care and possible violations of the right to confidentiality of patient information. Moreover, the law discussed here fails to emphasise the importance of physicians ensuring compliance by the patient, by sharing the correct information about the risks associated with illegal driving and by obtaining information from the patient through regular check-ups. An urgent revision of the law is required to implement the duty of the physician to provide information and to ensure that the rule about mandatory notification should be erased in favour of optional self-reporting by epileptics as the preferred way to notify the licensing authority. The implementation of these measures could correct the dichotomy between the law and the ethical recommendations for medical doctors and protect the rights of people with epilepsy as well as those of any other patients whose pathology or impairment could imply a risk to the community.
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Affiliation(s)
- Vilma Pinchi
- Department of Health Sciences -Section of Forensic Sciences, University of Florence, Institute of Legal Medicine, Florence, Italy
| | - Gian-Aristide Norelli
- Department of Health Sciences -Section of Forensic Sciences, University of Florence, Institute of Legal Medicine, Florence, Italy
| | - Viola Bartolini
- Department of Health Sciences -Section of Forensic Sciences, University of Florence, Institute of Legal Medicine, Florence, Italy
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Bautista RED, Shapovalov D, Saada F, Pizzi MA. The societal integration of individuals with epilepsy: perspectives for the 21st century. Epilepsy Behav 2014; 35:42-9. [PMID: 24798409 DOI: 10.1016/j.yebeh.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 11/16/2022]
Abstract
Epilepsy is a common neurologic disorder seen throughout the world. Advances in therapy have made it possible for persons with epilepsy (PWEs) to have improved seizure control and a better quality of life. However, it is not entirely clear whether this has resulted in their successful integration into society. This review examines the societal integration of PWEs, identifying both the progress made and the challenges that continue to hamper further advances. In general, PWEs are more integrated in western-oriented cultures. However, there continue to be ongoing difficulties due to poor education and intellectual functioning, poor social and family support, the undertreatment of coexisting psychiatric conditions, transportation and mobility limitations, and problems obtaining employment. This review also discusses the effects of low socioeconomic status on integration and the persisting prejudices that affect certain racial groups. Most importantly, this review underscores the fact that societal stigma towards PWEs is still very much alive. At the beginning of the 21st century, PWEs still encounter difficulties in their quest for full societal integration. Along with medical advances being made to improve seizure control, much still has to be done to bring about the reforms necessary to help PWEs live more meaningful and productive lives.
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Affiliation(s)
- Ramon Edmundo D Bautista
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA.
| | - Denys Shapovalov
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Fahed Saada
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Michael A Pizzi
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
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15
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Chen WC, Chen EY, Gebre RZ, Johnson MR, Li N, Vitkovskiy P, Blumenfeld H. Epilepsy and driving: potential impact of transient impaired consciousness. Epilepsy Behav 2014; 30:50-7. [PMID: 24436967 PMCID: PMC4098969 DOI: 10.1016/j.yebeh.2013.09.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Driving is an important part of everyday life for most adults, and restrictions on driving can place a significant burden on individuals diagnosed with epilepsy. Although sensorimotor deficits during seizures may impair driving, decreased level of consciousness often has a more global effect on patients' ability to respond appropriately to the environment. Better understanding of the mechanisms underlying alteration of consciousness in epilepsy is important for decision-making by people with epilepsy, their physicians, and regulators in regard to the question of fitness to drive. Retrospective cohort and cross-sectional studies based on surveys or crash records can provide valuable information about driving in epilepsy. However, prospective objective testing of ictal driving ability during different types of seizures is needed to more fully understand the role of impaired consciousness and other deficits in disrupting driving. Driving simulators adapted for use in the epilepsy video-EEG monitoring unit may be well suited to provide both ictal and interictal data in patients with epilepsy. Objective information about impaired driving in specific types of epilepsy and seizures can provide better informed recommendations regarding fitness to drive, potentially improving the quality of life of people living with epilepsy.
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Affiliation(s)
- William C. Chen
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Eric Y. Chen
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Rahiwa Z. Gebre
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Michelle R. Johnson
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Ningcheng Li
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Petr Vitkovskiy
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA,Department of Neurobiology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA,Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
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