哪里些癫痫患者可以安全地驾驶?


  研究人员正在进一步确定,应该允许哪里些癫痫患者开车。一篇新分析认为,诸如癫痫发作持续时间和意识受损等因素,会影响后来的驾驶功能。
  
  第一作者、康乃狄克纽哈芬耶鲁医学院神经与神经科学暨神经外科教授、癫痫专家Hal Blumenfeld博士表示,我们的目标是,找出告知医师与患者是否可安全驾驶的相关线索。
  
  他表示,很多时候,可以安全驾驶的癫痫患者被与所有癫痫患者相提并论,而禁止他们坐上驾驶座。
  
  这些研究结果发表于美国癫痫协会(AES)2016年会。
  
  为了此次分析,癫痫患者进行了影片/脑波电流描记监测,借以分析从驾驶模拟器获得的发作期与间期的驾驶资料,这个模拟器有方向盘、加速踏板和煞车,连接到笔记型计算机。
  
  参与者被要求尽可能模拟驾驶,如果可能的话,继续驾驶到他们癫痫发作为止。该试验是在可以在必要时提供医疗协助的住院单位进行,参与者驾驶时间为1-10小时,大部份是平均3-4小时。
  
  研究者考虑的变项包括:车速、方向盘操控、煞车踏板的应用,以及在发作期和事后期与在亚临床癫痫样放电期间发生的碰撞。
  
  发表于年会的海报中,研究者报告了16名患者的20次临床癫痫发作分析,其中7次发作导致碰撞。
  
  分析确定,癫痫发作时间越长,人发生事故的可能性越大。Blumenfeld博士表示,发生碰撞者的发作时间平均为80秒,而没有影响驾驶的发作时间平均为23秒,所以,平均来说,发生碰撞者的发作时间比较长。
  
  但是,这次分析并未提供发作的时间限制,Blumenfeld博士表示,迄今,分析显示持续时间更长的癫痫发作会更危险;但是我们还没有阈值数据,那将会有所帮助。
  
  他强调,这些是平均值,而其它因素如严重的运动损伤和意识丧失,都会影响安全。
  
  此次研究也显示,当患者在癫痫发作期间失去意识时,他们显然更有可能发生碰撞(P < .05)。Blumenfeld博士表示,这是基于常识的理由,但没有人真正测试过。
  
  他和研究伙伴计划进行更多研究,探讨可能影响安全的其它事情,例如,发作根源是脑的哪里个部分。我们可能可以汇整一些因素于某个模式中,提出一个实际的决策树,我们还没做到,但这是目标。
  
  有关癫痫驾驶的规则和法规,在世界各地显著不同。例如,在印度,发作一次癫痫即代表你终生不能驾驶。
  
  在美国,各州规定不一,要求3个月、6个月或2年没有发作,康乃狄克等其它州则是没有设定限制,而是将驾驶决定留给临床医生判断。
  
  Blumenfeld博士表示,所以,它显示我们真的不知道应该如何限制,我们基本上是从回溯性研究和问卷调查获得常识和一些信息。
  
  他认为,应该有关于癫痫和驾驶之统一的全球规定,因为在目前的氛围下,对医生、患者和一般公众来说都很混乱。
  
  当有事故发生时,每个人都互相责怪,因为在指导方针或共识并未达成一致。
  
  加州史丹佛大学癫痫综合中心主任、神经与神经学教授Robert Fisher博士希望,当论及驾驶时,癫痫患者能被公平对待;我们不希望癫痫患者撞车,但我们也不希望他们受到不公平的歧视。
  
  Fisher博士曾发表有关驾驶与癫痫的论文,并在涉及癫痫患者的车祸案件中担任辩方证人。
  
  他指出,在美国,癫痫妇女的车祸比率低于没有癫痫的男性-特别是18-25岁的驾驶者。这并不意味著癫痫不是一个危险因素,它只是意味著它真的应该个别考量。
  
  Fisher博士表示,虽然具有不受控制之癫痫发作的患者不应开车,那些癫痫发作已被控制达特定时间者之风险已低于我们可接受的条件。
  
  他指出,驾驶是癫痫门诊讨论最多的话题之一,也造成医病关系的显著压力。
  
  资料来源: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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