Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation

Overview

Journal Neurology

Specialty Neurology

Date 2023 Jul 6

PMID 37414567

Authors

Heinz Krestel

David R Schreier

Elmaze Sakiri

Andreas von Allmen

Yasmina Abukhadra

Arto Nirkko

Maja Steinlin

Felix Rosenow

Rune Markhus

Gaby Schneider

Caroline Jagella

Johannes Mathis

Hal Blumenfeld

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: This study aimed to evaluate and predict the effects of interictal epileptiform discharges (IEDs) on driving ability using simple reaction tests and a driving simulator.

Methods: Patients with various epilepsies were evaluated with simultaneous EEGs during their response to visual stimuli in a single-flash test, a car-driving video game, and a realistic driving simulator. Reaction times (RTs) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered in this study, were a series of epileptiform potentials (>1 potential) and were classified as generalized typical, generalized atypical, or focal. RT and miss/crash in relation to IED type, duration, and test type were analyzed. RT prolongation, miss/crash probability, and odds ratio (OR) of miss/crash due to IEDs were calculated.

Results: Generalized typical IEDs prolonged RT by 164 ms, compared with generalized atypical IEDs (77.0 ms) and focal IEDs (48.0 ms) ( < 0.01). Generalized typical IEDs had a session miss/crash probability of 14.7% compared with a zero median for focal and generalized atypical IEDs ( < 0.01). Long repetitive bursts of focal IEDs lasting >2 seconds had a 2.6% miss/crash probability. Cumulated miss/crash probability could be predicted from RT prolongation: 90.3 ms yielded a 20% miss/crash probability. All tests were nonsuperior to each other in detecting miss/crash probabilities (zero median for all 3 tests) or RT prolongations (flash test: 56.4 ms, car-driving video game: 75.5 ms, simulator 86.6 ms). IEDs increased the OR of miss/crash in the simulator by 4.9-fold compared with normal EEG. A table of expected RT prolongations and miss/crash probabilities for IEDs of a given type and duration was created.

Discussion: IED-associated miss/crash probability and RT prolongation were comparably well detected by all tests. Long focal IED bursts carry a low risk, while generalized typical IEDs are the primary cause of miss/crash. We propose a cumulative 20% miss/crash risk at an RT prolongation of 90.3 ms as a clinically relevant IED effect. The IED-associated OR in the simulator approximates the effects of sleepiness or low blood alcohol level while driving on real roads. A decision aid for fitness-to-drive evaluation was created by providing the expected RT prolongations and misses/crashes when IEDs of a certain type and duration are detected in routine EEG.

Citing Articles

Electroencephalographic compatibility with fitness to drive: A nationwide survey among Swiss neurologists.

Spondlin L, Hardmeier M, Sutter R, Lee J, Ruegg S, Fisch U Epilepsia Open. 2024; 9(6):2219-2229.

PMID: 39230999 PMC: 11633678. DOI: 10.1002/epi4.13041.

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