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First Seizure While Driving (FSWD) — An Underestimated Phenomenon?

Published online by Cambridge University Press:  23 September 2014

Bernd Pohlmann-Eden ,
Nina Hynick  and
Karen Legg
Bernd Pohlmann-Eden*
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
Nina Hynick
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
Karen Legg
Affiliation:
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
*
Division of Neurology, Room No 3838 Halifax Infirmary, Dalhousie University, 1796 Summer St, Halifax, Nova Scotia, B3H 3A7, Canada. Email: B.Pohlmann-Eden@dal.ca
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Abstract:

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Background:

Seizures while driving are a well known occurrence in established epilepsy and have significant impact on driving privileges. There is no data available on patients who experience their first (diagnosed) seizure while driving (FSWD).

Method:

Out of 311 patients presenting to the Halifax First Seizure Clinic between 2008 and 2011, 158 patients met the criteria of a first seizure (FS) or drug-naïve, newly diagnosed epilepsy (NDE). A retrospective chart review was conducted. FSWD was evaluated for 1) prevalence, 2) clinical presentation, 3) coping strategies, and 4) length of time driving before seizure occurrence.

Results:

The prevalence of FSWD was 8.2%. All 13 patients experienced impaired consciousness. Eleven patients had generalized tonic-clonic seizures, one starting with a déjà-vu evolving to visual aura and a complex partial seizure; three directly from visual auras. Two patients had complex partial seizures, one starting with an autonomic seizure. In response to their seizure, patients reported they were i) able to actively stop the car (n=4, three had visual auras), ii) not able to stop the car resulting in accident (n=7), or iii) passenger was able to pull the car over (n=2). One accident was fatal to the other party. Twelve out of 13 patients had been driving for less than one hour.

Discussion:

FSWD is frequent and possibly underrecognized. FSWD often lead to accidents, which occur less if preceded by simple partial seizures. Pathophysiological mechanisms remain uncertain; it is still speculative if complex visuo-motor tasks required while driving play a role in this scenario.

Résumé:

Résumé:Contexte:

Les crises convulsives survenant lors de la conduite d'un véhicule automobile sont un phénomène bien établi dans l'épilepsie et ont un impact significatif sur le permis de conduire. Il n'y a pas de données sur les patients qui ont leur première crise convulsive (diagnostiquée) en conduisant (PCCC).

Méthode:

Parmi les 311 patients examinés à la clinique de consultation pour une première crise convulsive à Halifax entre 2008 et 2011, 158 patients rencontraient les critères d'une première crise convulsive ou d'une épilepsie nouvellement diagnostiquée alors que le patient était sans traitement. Nous avons effectué une revue rétrospective de ces dossiers. Nous avons évalué la prévalence de la PCCC, sa présentation clinique, les stratégies d'adaptation et depuis combien de temps le patient conduisait avant que la crise convulsive ne survienne.

Résultats:

La prévalence de la PCCC était de 8,2%. Treize patients ont présenté une altération de l'état de conscience. Onze patients ont présenté une crise tonico-clonique généralisée, une crise ayant débuté par un déjà-vu évoluant en aura visuel et une crise partielle complexe, et chez 3 patients elle a été précédée directement d'auras visuels. Deux patients ont eu des crises partielles complexes dont l'une a débuté par une crise d'épilepsie autonome. En réponse à leur crise, les patients ont rapporté soit qu'ils avaient été capables d'arrêter l'automobile (n = 4, trois avec aura visuel), qu'ils n'ont pas été capables d'arrêter l'automobile ce qui a provoqué un accident (n = 7), ou que le passager a été capable d'arrêter l'automobile en bordure de la route (n = 2). Un accident a causé la mort d'occupants dans le véhicule qui a été heurté. Douze des 13 patients conduisaient depuis moins d'une heure au moment de la crise.

Discussion:

Une PCCC est un phénomène fréquent et potentiellement sous-diagnostiqué. Une PCCC est souvent la cause d'accidents, moins fréquemment si elle est précédée par une crise d'épilepsie partielle simple. Ses mécanismes physiopathologiques demeurent obscurs et et nous ne savons pas si les tâches visuo-motrices complexes exigées pour la conduite automobile y contribuent.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 4 , July 2013 , pp. 540 - 545
Copyright
Copyright © The Canadian Journal of Neurological 2013

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