title: Virtual car accidents of epilepsy patients, interictal epileptic activity, and medication.
abstract: To investigate effects of interictal epileptic activity (IEA) and antiepileptic drugs (AEDs) on reactivity and aspects of the fitness to drive for epilepsy patients.
  
  
  
  Forty-six adult patients with demonstration of focal or generalized bursts of IEA in electroencephalography (EEG) readings within 1 year prior to inclusion irrespective of medication performed a car driving computer test or a single light flash test (39 patients performed both). Reaction times (RTs), virtual crashes, or lapses (RT ≥ 1 s in the car or flash test) were measured in an IEA burst-triggered fashion during IEA and compared with RT-measurements during unremarkable EEG findings in the same session.
  
  
  
  IEA prolonged RTs both in the flash and car test (p < 0.001) in individual patients up to 200 ms. Generalized IEA with spike/waves (s/w) had the largest effect on RT prolongation (p < 0.001, both tests), whereas mean RT during normal EEG, age, gender, and number of AEDs had no effect. The car test was better than the flash test in detecting RT prolongations (p = 0.030). IEA increased crashes/lapses >26% in sessions with generalized IEA with s/w. The frequency of IEA-associated RT >1 s exceeded predictions (p < 0.001) based on simple RT shift, suggesting functional impairment beyond progressive RT prolongation by IEA. The number of AEDs correlated with prolonged RTs during normal EEG (p < 0.021) but not with IEA-associated RT prolongation or crashes/lapses.
  
  
  
  IEA prolonged RTs to varying extents, dependent on IEA type. IEA-associated RTs >1 s were more frequent than predicted, suggesting beginning cerebral decompensation of visual stimulus processing. AEDs somewhat reduced psychomotor speed, but it was mainly the IEA that contributed to an excess of virtual accidents.
authors.affiliation: Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Arto C
authors.initials: AC
authors.lastname: Nirkko
authors.affiliation: Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Corrado
authors.initials: C
authors.lastname: Bernasconi
authors.affiliation: Department of Medical Electronics, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: von Allmen
authors.affiliation: Department of Medical Electronics, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Liechti
authors.affiliation: Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Mathis
authors.affiliation: Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Heinz
authors.initials: H
authors.lastname: Krestel
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011930:Reaction Time / Q000187:drug effects; D014584:User-Computer Interface; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drugs; Driving simulator; Fitness to drive; Patient safety; Reactivity