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Occurrence of wake seizures after pure sleep epilepsy: a systematic review and implications for driving law [Cpmference Abstract]

Thomas, Rhys Huw, King, W. H., Johnston, J. A. and Smith, Philip E. M. 2009. Occurrence of wake seizures after pure sleep epilepsy: a systematic review and implications for driving law [Cpmference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 80 , e1-e1. 10.1136/jnnp.2009.195172o

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Abstract

Who with sleep seizures is safe to drive? Driving law is controversial; ineligibility varies between individual US states and EU countries. Current UK driving law is based on a single-centre study from 1974 where most participants were untreated. However, medication often controls pure sleep-related epilepsy (PSE) and medication withdrawal often provokes wake seizures. This systematic review asked, ‘‘What is the risk of awake seizures in PSE?’’ 9885 titles were identified; 2312 excluded (not human or adult); 40 full text review; six papers met our inclusion criteria; each had a different PSE definition. Using the largest prospective study (D’Alessandro 2004), we could calculate next year’s wake seizure chance (treated): maximal in second year; 5.7% 95% CI (3.0 to 10.4%), relative risk (RR) 1.3. The DVLA broadly accepts RR of ,2.0 for Group 1 licensing. However, this study excluded frontal lobe epilepsies. Furthermore, follow-up (n=160) varied from 2–6 years, yet new awake seizures may occur even after 10–20 years of PSE. A paucity of evidence underpins licensing law; current rulings would be difficult to defend if legally challenged. We may be both penalising people with PSE without increased risk of wake seizures, while failing to identify subgroups at unacceptable risk of an awake seizure at the wheel.

Item Type: Article
Date Type: Publication
Status: Published
Schools: MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Publisher: BMJ Publishing Group
ISSN: 0022-3050
Last Modified: 04 Jun 2017 08:59
URI: http://orca.cf.ac.uk/id/eprint/88834

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