Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law.
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 strongly influenced by a single-centre study from 1974 where most participants were not taking antiepileptic drugs (AEDs). However, pure sleep-related epilepsy is often fully controlled on medication, and its withdrawal can provoke awake seizures. This systematic review asked, 'What is the risk of awake seizures in pure sleep-related epilepsy?' 9885 titles were identified; 2312 were excluded (not human or adult); 40 full texts were reviewed; six papers met our inclusion criteria; each of these six studies had a different pure sleep-related epilepsy definition. Using the largest prospective study, we were able to calculate next year's awake seizure chance (treated with antiepileptic medication). This was maximal in the second year: 5.7% (95% CI 3.0 to 10.4%). European licensing bodies including the UK's Driver and Vehicle Licensing Agency broadly accept a risk of less than 20% for Group 1 licensing. However, this study excluded patients with frontal-lobe epilepsies. Furthermore, follow-up (n=160) varied from 2 to 6 years, yet new awake seizures may occur even after 10-20 years of pure sleep-related epilepsy A paucity of evidence underpins present licensing law; current rulings would be difficult to defend if legally challenged. The law may be penalising people with pure sleep-related epilepsy without increased risk of awake seizures, while failing to identify subgroups at unacceptable risk of an awake seizure at the wheel.
Thomas
R H
RH
Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Singleton Park, SA2 8PP, UK. rhys-thomas@doctors.org.uk
King
W H
WH
Johnston
J A
JA
Smith
P E M
PE
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000627:therapeutic use; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D017034:Epilepsy, Frontal Lobe / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology*; D012890:Sleep; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014851:Wakefulness
D000927:Anticonvulsants