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.
Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Singleton Park, SA2 8PP, UK. rhys-thomas@doctors.org.uk
R H
RH
Thomas
W H
WH
King
J A
JA
Johnston
P E M
PE
Smith
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