哪些癲癇患者可以安全地駕駛?


  研究人員正在進一步確定,應該允許哪些癲癇患者開車。一篇新分析認為,諸如癲癇發作持續時間和意識受損等因素,會影響後來的駕駛功能。
  
  第一作者、康乃狄克紐哈芬耶魯醫學院神經與神經科學暨神經外科教授、癲癇專家Hal Blumenfeld博士表示,我們的目標是,找出告知醫師與患者是否可安全駕駛的相關線索。
  
  他表示,很多時候,可以安全駕駛的癲癇患者被與所有癲癇患者相提並論,而禁止他們坐上駕駛座。
  
  這些研究結果發表於美國癲癇協會(AES)2016年會。
  
  為了此次分析,癲癇患者進行了影片/腦波電流描記監測,藉以分析從駕駛模擬器獲得的發作期與間期的駕駛資料,這個模擬器有方向盤、加速踏板和煞車,連接到筆記型電腦。
  
  參與者被要求盡可能模擬駕駛,如果可能的話,繼續駕駛到他們癲癇發作為止。該試驗是在可以在必要時提供醫療協助的住院單位進行,參與者駕駛時間為1-10小時,大部份是平均3-4小時。
  
  研究者考慮的變項包括:車速、方向盤操控、煞車踏板的應用,以及在發作期和事後期與在亞臨床癲癇樣放電期間發生的碰撞。
  
  發表於年會的海報中,研究者報告了16名患者的20次臨床癲癇發作分析,其中7次發作導致碰撞。
  
  分析確定,癲癇發作時間越長,人發生事故的可能性越大。Blumenfeld博士表示,發生碰撞者的發作時間平均為80秒,而沒有影響駕駛的發作時間平均為23秒,所以,平均來說,發生碰撞者的發作時間比較長。
  
  但是,這次分析並未提供發作的時間限制,Blumenfeld博士表示,迄今,分析顯示持續時間更長的癲癇發作會更危險;但是我們還沒有閾值數據,那將會有所幫助。
  
  他強調,這些是平均值,而其他因素如嚴重的運動損傷和意識喪失,都會影響安全。
  
  此次研究也顯示,當患者在癲癇發作期間失去意識時,他們顯然更有可能發生碰撞(P < .05)。Blumenfeld博士表示,這是基於常識的理由,但沒有人真正測試過。
  
  他和研究夥伴計劃進行更多研究,探討可能影響安全的其他事情,例如,發作根源是腦的哪個部分。我們可能可以彙整一些因素於某個模式中,提出一個實際的決策樹,我們還沒做到,但這是目標。
  
  有關癲癇駕駛的規則和法規,在世界各地顯著不同。例如,在印度,發作一次癲癇即代表你終生不能駕駛。
  
  在美國,各州規定不一,要求3個月、6個月或2年沒有發作,康乃狄克等其他州則是沒有設定限制,而是將駕駛決定留給臨床醫生判斷。
  
  Blumenfeld博士表示,所以,它顯示我們真的不知道應該如何限制,我們基本上是從回溯性研究和問卷調查獲得常識和一些資訊。
  
  他認為,應該有關於癲癇和駕駛之統一的全球規定,因為在目前的氛圍下,對醫生、患者和一般公眾來說都很混亂。
  
  當有事故發生時,每個人都互相責怪,因為在指導方針或共識並未達成一致。
  
  加州史丹佛大學癲癇綜合中心主任、神經與神經學教授Robert Fisher博士希望,當論及駕駛時,癲癇患者能被公平對待;我們不希望癲癇患者撞車,但我們也不希望他們受到不公平的歧視。
  
  Fisher博士曾發表有關駕駛與癲癇的論文,並在涉及癲癇患者的車禍案件中擔任辯方證人。
  
  他指出,在美國,癲癇婦女的車禍比率低於沒有癲癇的男性-特別是18-25歲的駕駛者。這並不意味著癲癇不是一個危險因素,它只是意味著它真的應該個別考量。
  
  Fisher博士表示,雖然具有不受控制之癲癇發作的患者不應開車,那些癲癇發作已被控制達特定時間者之風險已低於我們可接受的條件。
  
  他指出,駕駛是癲癇門診討論最多的話題之一,也造成醫病關係的顯著壓力。
  
  資料來源:http://www.24drs.com/
  
  Native link:Which Patients With Epilepsy Can Safely Drive?

Which Patients With Epilepsy Can Safely Drive?

By Pauline Anderson
Medscape Medical News

HOUSTON — Researchers are making headway in determining which patients with epilepsy should be allowed to drive.

A new analysis suggests that factors such as seizure duration and impaired consciousness influence later driving performance.

"Our goal is to figure out if there are clues" that will "inform doctors and patients" about whether it's safe to drive, said epilepsy specialist and lead study author, Hal Blumenfeld, MD, PhD, professor of neurology, neuroscience and neurosurgery, Yale School of Medicine, New Haven, Connecticut.

All too often, he said, patients with epilepsy who can safely drive are "lumped together" with all patients with epilepsy and discouraged from getting behind the wheel.

The researchers' findings were presented here at the American Epilepsy Society (AES) 2016 Annual Meeting.

For this analysis, patients with epilepsy underwent video/electroencephalographic monitoring that analyzed ictal and interictal driving data captured prospectively from a driving simulator. The simulator had a steering wheel, gas pedal, and brake attached to a laptop computer.

Participants were asked to drive as long as they could and, if possible, to continue to drive if they had a seizure. The test was conducted in an inpatient unit with medical care available if needed. Patients drove from 1 to 10 hours, most for an average of 3 to 4 hours.

The variables researchers considered included car velocity, steering wheel movement, application of the brake pedal, and crash occurrence during the ictal and postictal periods, as well as during subclinical epileptiform discharges.

In a poster presented at the meeting, investigators reported an analysis of a total of 20 clinical seizures in 16 patients. Seven of these seizures resulted in crashes.

The analysis determined that the longer the seizure, the more likely the person was to have an accident. "The average for people who crash is 80 seconds and the average for the ones who don't have driving impairment is 23 seconds, so on average, the seizures are longer" in those who crash, said Dr Blumenfeld.

No Time Limit

But the analysis doesn't provide a time limit for seizures. "So far, this shows that seizures lasting longer are more dangerous; but we don't have a cutoff yet," said Dr Blumenfeld. "That's one thing that could be helpful."

He stressed that these are averages and that other factors, such as severe motor impairment and loss of consciousness, contribute to safety.

The current study also showed that when patients lose consciousness during seizures, they are significantly more likely to crash (P < .05). "That stands to reason based on common sense, but no one had really tested that before," said Dr Blumenfeld.

He and his colleagues plan to do additional research, looking at other things that might affect safety, for example, from what part of the brain seizures originate.

"There may be factors that we can put together in a model and come up with a real decision tree," he said. "We aren't there yet, but that's the goal."

Rules and regulations surrounding driving with epilepsy vary significantly around the world. In India, for example, having a single seizure means you can't drive for life.

In the United States, states variously require 2 years, 6 months, or 3 months of seizure freedom, while others, including Connecticut, don't have a set limit but leave the driving decision to the discretion of the clinician.

"So it goes to show that we really don't know what the limit should be," said Dr Blumenfeld. "We are working basically out of common sense and little bits of information available from retrospective studies and questionnaires."

He thinks there should be uniform global regulations concerning epilepsy and driving because under the current climate, "it's very confusing for physicians, for patients and for the general public."

"When there are accidents, everyone blames everyone else because nobody has agreement on what the guidelines or consensus should be."

Fair Treatment

Robert Fisher, MD, PhD, professor of neurology and neurological sciences, and director, Comprehensive Epilepsy Center, Stanford University, California, wants patients with epilepsy to be treated justly when it comes to driving.

"We don't want people with epilepsy to crash a car, but we don't want them to be unfairly discriminated against either."

Dr Fisher has published articles on driving and epilepsy and has been a defense witness in cases involving patients with epilepsy who have been in a motor vehicle accident.

He pointed out that in the United States, the accident rate for women with epilepsy is lower than for men without epilepsy, especially among drivers 18 to 25 years old.

"That doesn't mean that epilepsy is not a risk factor; it just means that it really ought to be individualized," he said.

While patients with uncontrolled seizures shouldn't drive, those whose seizures have been controlled for a specific length of time "have a risk that's lower than we are willing to accept for a number of conditions," said Dr Fisher.

Driving is "one of the most discussed" topics in the epilepsy clinic and can contribute to significant stress in the doctor–patient relationship, he noted.

American Epilepsy Society (AES) 2016 Annual Meeting. Poster 2.276. Presented December 4, 2016.

    
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