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Epilepsy and driving: an international perspective. Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy.

Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, such as Canada and the United States, allow driving < or = 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of medical literature and existing practices, a series of proposed guidelines for driving and epilepsy is recommended. In general, these guidelines suggest use of a seizure-free interval, generally 1-2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patients whom they believe pose a danger to themselves and to public safety. Individualized consideration should be given to special circumstances that may modify a general driving prohibition. Education and information programs are necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsy worldwide.

Accidents, Traffic↗

PubMed1997

Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly.

OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped. DESIGN: Cohort study. SETTING: Urban community. PARTICIPANTS: A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and the remainder had either never driven or had stopped before 1982. MEASUREMENTS: Information about independent and dependent variables other than driving status came from the in person EPESE interviews in 1982, 1985, and 1988, except for medical conditions, which were updated yearly. Depressive symptoms were assessed by the Centers for Epidemiologic Studies-Depression (CES-D) scale. Analyses focused on the changes in depressive symptoms before and after driving cessation. Repeated measures multivariable analysis accounted for the effect of cessation on the outcome adjusting for the potential confounding due to sociodemographic and health-related factors. RESULTS: Individuals who stopped driving exhibited substantial increases in depressive symptoms during the 6-year interval. Driving cessation was among the strongest predictors of increased depressive symptoms (Coefficient 2.464, SE 0.758, P = .001) even when adjusting for sociodemographic and health-related factors. CONCLUSIONS: Driving cessation was associated with an increase in depressive symptoms even when accounting for sociodemographic and health-related factors. These consequences need to be taken into account when advising older drivers and when developing alternative transportation strategies.

Aged↗

PubMed1997

Modification of patient driving behavior after implantation of a cardioverter defibrillator.

Driving habits among recipients of ICDs have not been well characterized previously, yet such information may have implications for development of national policy. This study was undertaken to characterize driving behavior after defibrillator implantation in our patient population. From 1988-1993, 82 ICDs were implanted at the University of Florida. All patients received defibrillator teaching preoperatively and postoperatively with particular emphasis placed on driving restrictions. A standardized questionnaire was developed to ascertain driving behavior, compliance with restrictions, and occurrence of motor vehicle accidents following implantation. The patients were divided into two groups according to whether or not they had received a shock from their device since implantation. Group I patients did, and Group II patients did not. Fifty-two out of 82 (63%, Group I) patients had at least one shock. The remaining 30 patients had received no shocks. Mean age and gender were no different between the two groups. Mean time since implantation was 6 +/- 1.3 years in Group I, compared to 4 +/- 1.5 years in Group II (P = 0.001). Forty-seven out of 52 (90%) and 26 out of 30 (87%) in Groups I and II, respectively, resumed driving after defibrillator implantation. There was no difference in the amount of time that passed prior to resumption of driving. Group I patients drove more, 20.5 +/- 27 miles/day compared to patients in Group II, 8.3 +/- 9.7 miles/day (P = 0.02). No patient experienced device discharge during driving; likewise, no patient was involved in a motor vehicle accident secondary to their device firing. Sixty-seven out of 82 (82%) patients complied with the instructions they thought they heard; seven patients in Group I and eight patients in Group II deliberately did not follow our advice. The majority of patients do comply with physician instructions, although the instructions they remember are not always the instructions given. If a national policy is created to prohibit driving after ICD implantation, effective enforcement may be difficult.

Accidents, Traffic↗

PubMed1996

Drive-by shootings by violent street gangs in Los Angeles: a five-year review from 1989 to 1993.

OBJECTIVE: To determine trends in the numbers of drive-by shootings, individuals shot at, innocent bystanders shot at, and homicides by drive-by shootings in the city of Los Angeles from 1989 to 1993. METHODS: A retrospective analysis of police records was performed for all gang-related drive-by shootings that occurred in the city of Los Angeles between 1989 and 1993. RESULTS: From 1989 to 1993, there were 6,327 drive-by shootings, 9,053 people shot at, and 590 homicides. There was an increase in drive-by shootings, people shot at, and homicides between 1989 and 1991, followed by a decrease between 1991 and 1993. The case fatality ratio of individuals killed to individuals shot at increased from 1989 to 1993 (p = 0.0011). Forty-seven percent of the people shot at, and 23% of the homicide victims, were innocent bystanders. CONCLUSION: Drive-by shootings are a major public health problem in Los Angeles. While the rate of drive-by shootings decreased in 1992 and 1993, the proportion of fatal cases increased. To prevent drive-by shootings, the root causes of violent street gang formation must be addressed.

Automobile Driving↗

PubMed1985

The development of the drive object concept in Freud's work: 1905-1915.

In 1905 Freud established the idea of an object of an instinctual drive as the basic object concept of psychoanalysis. He also introduced the derivative concepts of object directedness, object choice, and object finding. While taking these steps he simultaneously deemphasized the importance of drive objects in sexual life, contradicted himself on whether drives are autoerotic or object-directed in infancy, and made incompatible statements about whether or not object choice occurs before puberty. Freud's clinical work, reflected especially in the major case reports and a series of papers on fantasy, led to an apparent recognition of complexity in the mental life of children far greater than had been described earlier. The increased attention to and appreciation of mental content in childhood especially augmented Freud's understanding of the role of drive objects, object directedness, and object choice in infancy. This, in turn, led him to postulate a sequence of organizations of sexual life, named according to the zonal drive source plus the mode of object directedness, a process of theory development that continued through 1924. Object choice and, to a lesser extent, object directedness are concepts derived from and dependent upon the concept of drive object. Both require, however, explanatory constructs besides drive constructs. In 1915 Freud defined the term "object" in the context of stating his drive theory. Freud used the term object with several new modifying words during this decade. No new object concept was introduced, however, in this work, although some steps in that direction appeared to be in progress.

Child↗

PubMed2006

Acute and subchronic effects of amitriptyline 25mg on actual driving in chronic neuropathic pain patients.

The acute and subchronic effects of low doses nocturnally administered amitriptyline were compared to placebo in a double-blind crossover randomized study on driving ability and driving-related skills involving seven chronic neuropathic pain patients. Performance testing occurred at the first and last day of each 15-day drug administration period, which was preceded by a 6-day washout phase. A standardized method of measuring driving ability, the on-the-road driving test, was performed on all visits. Patients were instructed to drive with a steady lateral position while maintaining a constant speed of 95 km/h. The primary outcome of the driving test is the Standard Deviation of Lateral Position (SDLP, cm), which is an index of weaving of the car. At the first treatment day, driving performance was significantly impaired in patients after nocturnal administration of 25 mg amitriptyline compared to placebo. The increase in SDLP of 3 cm was higher than the increment generally observed with a blood alcohol concentration of 0.5 mg/ml or higher, the legal limit for driving in many countries. Also, reaction times on a memory test were significantly increased, indicating worse performance after acute treatment of amitriptyline compared to placebo. In contrast, after 2 weeks of treatment, no significant differences were found between amitriptyline and placebo, suggesting that tolerance had developed to the impairing effects of amitriptyline.

Adult↗

PubMed2006

Manual transmission enhances attention and driving performance of ADHD adolescent males: pilot study.

OBJECTIVE: Inattention is a major contributor to driving mishaps and is especially problematic among adolescent drivers with ADHD, possibly contributing to their 2 to 4 times higher incidence of collisions. Manual transmission has been demonstrated to be associated with greater arousal. This study tests the hypotheses that manual transmission, compared to automatic transmission, would be associated with better attention and performance on a driving simulator. METHOD: Ten adolescent drivers with ADHD practice driving on the simulator in the manual and automatic mode. Employing a single-blind, cross-over design, participants drive the simulator at 19:30 and 22:30 hr for 30 min in both transmissions and rate their attention to driving. RESULTS: Subjectively, participants report being more attentive while driving in manual transmission mode. Objectively, participants drive safer in the manual transmission mode. CONCLUSION: Although in need of replication, this pilot study suggests a behavioral intervention to improve driving performance among ADHD adolescents.

Accidents, Traffic↗

PubMed2004

A multimodal assessment of driving performance in HIV infection.

OBJECTIVE: To examine if HIV-seropositive (HIV+) individuals are at risk for impaired driving. METHODS: Sixty licensed drivers (40 HIV+, 20 HIV-) completed a neuropsychological (NP) test battery and driving assessments. Eleven HIV+ subjects were NP-impaired. Driving-related skills were assessed using 1) two driving simulations (examining accident avoidance and navigational abilities), 2) the Useful Field of View (UFOV) test, and 3) an on-road evaluation. RESULTS: HIV+ NP-impaired subjects had greater difficulty than cognitively intact subjects on all driving measures, whereas the HIV- and HIV+ NP-normal groups performed similarly. On the UFOV, the HIV+ NP-impaired group had worse performance on Visual Processing and Divided Attention tasks but not in overall risk classification. They also had a higher number of simulator accidents (1.3 vs 2.0; p = 0.03), were less efficient at completing the navigation task (3.2 vs 9.2 blocks; p = 0.001), and were more likely to fail the on-road evaluation (6 vs 36%; p = 0.02). Impairment in Executive Functioning was the strongest NP predictor of failing the on-road drive test. NP performance and both simulations independently contributed to a model predicting 48% of the variance in on-road performance. CONCLUSION: HIV+ NP-impaired individuals are at increased risk for on-road driving impairments, whereas HIV+ individuals with normal cognition are not at a significantly higher risk than HIV- subjects. Executive Functioning is most strongly associated with impaired on-road performance. Cognitive and simulator testing may each provide data in identifying driving-impaired individuals.

AIDS Dementia Complex↗

PubMed2001

The influence of cognitive impairment on driving performance in multiple sclerosis.

OBJECTIVE: To examine the influence of impaired cognitive processing on measures of driving skills in persons with MS. METHODS: Twenty-eight subjects with documented MS were divided into two groups-with [MS(+), n = 13] and without [MS(-), n = 15] cognitive impairment-based on neuropsychological performance. Healthy control (HC) subjects (n = 17) matched on age and driving experience were also studied. Driving-related skills were compared between the groups based on performance on two computerized driving tests: the Useful Field of Vision (UFOV) and the Neurocognitive Driving Test (NDT). RESULTS: The MS(+) group performed significantly worse than both the MS(-) and HC groups in the latency to perform several driving-specific functions on the NDT, but no overall group differences were observed in actual errors on the NDT. On the UFOV, when compared to MS(-) and HC subjects, the MS(+) group demonstrated poorer performance on two of the three subtests. Additionally, a significantly higher percentage of MS(+) individuals were rated within the high risk (probability of crash involvement) category, relative to the MS(-) and HC groups. CONCLUSIONS: Cognitive impairment can negatively affect driving-related skills in persons with MS and should be considered in the determination of driving ability.

Adult↗

PubMed2005

Driving habits and patterns in older men with glaucoma.

Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older adults. Consequences of glaucoma can mean changes in the ability to perform familiar tasks, including driving an automobile. We surveyed older drivers with glaucoma and a control comparison group in order to learn more about their driving habits and expectations about driving cessation. Findings indicate that compared to the control group, drivers with glaucoma are significantly more likely to change their driving habits with regard to driving at night (p=0.003), on freeways (p=0.05), and in unfamiliar areas (p=0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p=0.01). However, the drivers with glaucoma did not anticipate that their disease would force them to discontinue driving. Social workers play a pivotal role in coordinating the complex care needs of visually impaired elders. When driving skills are affected, social workers must address transportation, housing as well as quality of life concerns.

Adaptation, Psychological↗

PubMed2002

Age and visual impairment decrease driving performance as measured on a closed-road circuit.

In this study the effects of visual impairment and age on driving were investigated and related to visual function. Participants were 139 licensed drivers (young, middle-aged, and older participants with normal vision, and older participants with ocular disease). Driving performance was assessed during the daytime on a closed-road driving circuit. Visual performance was assessed using a vision testing battery. Age and visual impairment had a significant detrimental effect on recognition tasks (detection and recognition of signs and hazards), time to complete driving tasks (overall course time, reversing, and maneuvering), maneuvering ability, divided attention, and an overall driving performance index. All vision measures were significantly affected by group membership. A combination of motion sensitivity, useful field of view (UFOV), Pelli-Robson letter contrast sensitivity, and dynamic acuity could predict 50% of the variance in overall driving scores. These results indicate that older drivers with either normal vision or visual impairment had poorer driving performance compared with younger or middle-aged drivers with normal vision. The inclusion of tests such as motion sensitivity and the UFOV significantly improve the predictive power of vision tests for driving performance. Although such measures may not be practical for widespread screening, their application in selected cases should be considered.

Adult↗

PubMed2004

Predicting practical fitness to drive in drivers with visual field defects caused by ocular pathology.

Vision, viewing efficiency, visual attention, and on-road driving performance were assessed in 100 participants with central and/or peripheral visual field defects caused by ocular pathology. Driving was evaluated by the Dutch driving license authority making use of the protocol for investigating practical fitness to drive. A smaller percentage of participants with central visual field defects passed the on-road driving test, in comparison with participants with peripheral or mild field defects. The predictive power of a model based on the current vision requirements for driving significantly increased when taking compensatory viewing efficiency into account. The results of the latter model were comparable to those of a model based on tests of visual attention and contrast sensitivity. Despite the increased explained variance of practical fitness to drive when taking higher-order visual functions into account, sensitivity and specificity remained quite low, limiting the use of these tests in identifying unfit drivers. Actual or potential applications of this research include the development of training programs to improve practical fitness to drive in drivers with visual field defects.

Accidents, Traffic↗

PubMed1992

Cognitive and attitudinal factors in the analysis of alternatives to drunk driving.

The present study examined cognitive and attitudinal factors relevant to drunk-driving tendencies in individuals having zero, one and multiple drunk-driving convictions. Results indicate that the awareness of consequences of being in an accident was related to driving record but not to drunk-driving tendencies. In contrast, the awareness of consequences of being arrested for drunk driving (e.g., receiving fines, having one's name appear in the news and having a criminal record) was negatively related to drunk-driving tendencies. Attitudes toward alternatives to drunk driving (e.g., take a taxi, call a friend) were also negatively related to drunk-driving tendencies. The findings are discussed with respect to developing prevention programs.

Accidents, Traffic↗

PubMed2006

Gender differences among young drivers in the association between high-risk driving and substance use/environmental influences.

OBJECTIVE: The primary aim of this article is to assess young drivers' gender differences in the associations between substance use/environmental influences and high-risk driving behavior. METHOD: We determine the association of 12th-grade self-reported substance use/ environmental influences with high-risk driving behavior as quantified by the number of offenses, serious offenses, crashes, and single-vehicle crashes on state driving records during subjects' (N = 3,607; 51% male) first 4 years of licensure. RESULTS: The associations between high-risk driving and substance use/environmental influences were generally stronger among women than among men. When matched by substance-use profiles, women had fewer risky-driving incidents than men. CONCLUSIONS: The results indicate that young women who exhibit high-risk driving behavior deviate more from the general population of young women with respect to alcohol use, alcohol misuse, and marijuana use than high-risk-driving young men differ from other young men. In addition, findings indicate that even if young men and women were to eventually have equal levels of substance use, women would likely retain their lower-risk driving profiles. These findings suggest the need for (1) future research to understand the differential associations, and (2) prevention programs that consider these gender differences.

Accidents, Traffic↗

PubMed1979

Drugs, alcohol and driving.

Driving a car is a complex psychomotor and perceptual task which is subject to impairment by many factors. Several workers have studied the potential effects of drugs and alchol in crash production by epidemiological and laboratory studies. Both types of studies have yielded useful data but their limitations must be borne in mind when applying the results in pratice. Alcohol is obviously the most common single cause of traffic accidents. A progessively increased risk with increasing blood alcohol levels is well documented; fatigue and/or drugs increase this risk. Drugs are related much more infrequently to traffic accidents although on the basis of statistics, there is a potential risk with drug use. However, drugs alone are not as important as alcohol. The most significant drugs as regards driving risk are obviously certain antianxiety agents, hypnotics, stimulants, hallucinogens, marihuana, lithium and narcotic analgesics, as well as ganglionic blocking agents, insulin and sulphonylurea derivates. Patients should not drive after taking these drug until they are objectively fully alert and capable. Anticholinergics, antihistamines, antidepressants, antipsychotics, phenybutazone, indomethacin, alpha-methyldopa, and beta-blockers may in some cases cause central side effects (e.g. drowsiness) strong enough to affect driving performance. After starting therapy with these drugs, or after a significant change in dose, driving should be avoided until it is known that unwanted effects do not occur. Psychotropic drugs may enhance the deleterious effect of alcohol, and with most hypnotics there is still an effect the next morning. Some drugs (e.g. anticonvulsants or antiparkinsonian drugs) may make driving safer, but the disease (epilepsy, Parkinsonism, cardiovascular diseases, psychic disorders, etc.) ofter precludes driving. Clinicians should warn their patients about an impairment of driving skills if this is likely to occur due to the drug or the illness concerned.

Alcohol Drinking↗

PubMed2006

The effects of fatal vision goggles on drinking and driving intentions in college students.

The present study was designed to examine the effectiveness of Fatal Vision Goggles in reducing intentions to drink and drive. Participants performed a field sobriety task and drove in a traffic simulator while wearing the goggles. A regression analysis was performed in order to predict changes in intentions to drink and drive, using typical drinking patterns, perceived likelihood of getting into a collision when drinking and driving, self efficacy, and driving independence as predictor variables. Results showed that drinking and driving intentions were reduced following the use of Fatal Vision Goggles among those that typically drink more during outings, among those that believe the likelihood of collisions when drinking and driving are greater, and among those less likely to drive to achieve independence and autonomy. These results indicate that Fatal Vision Goggles can be an effective tool in altering drinking and driving attitudes among drivers with specific attitudinal and personal characteristics.

Adolescent↗

PubMed1994

Development of a driving anger scale.

A cluster analysis of responses from more than 1500 college students to 53 potentially angering driving-related situations yielded a 33-item driving anger scale (alpha reliability = .90) with six reliable subscales involving hostile gestures, illegal driving, police presence, slow driving, discourtesy, and traffic obstructions. Subscales all correlated positively, suggesting a general dimension of driving anger as well as anger related to specific driving-related situations. Men were more angered by police presence and slow driving whereas women were more angered by illegal behavior and traffic obstructions, but differences compensated so there were no gender differences on total score. A 14-item short form (alpha reliability = .80) was developed from scores more highly correlated (r = .95) with scores on the long form. Driving anger may have potential value for research on accident prevention and health psychology.

Accidents, Traffic↗

PubMed1990

Peer attitudes, sex, and the effects of alcohol on simulated driving performance.

This study presents an investigation of the effects of peer attitude, gender, and blood alcohol level on driving performance using a driving simulator. The subjects were 18 male and 18 female social drinkers from the general population, aged 18-25, and holding a current drivers' licence. Subjects were randomly assigned to pro or against drinking driving conditions and tested at different blood alcohol levels. The results revealed that subjects in the for drinking driving condition perceived themselves to be more capable than they actually were and drove increasingly faster and made more mistakes than subjects in the against drinking driving condition when under the influence of alcohol. Significant sex differences were observed only for performance on the driving simulator. Males, in the main, engaged in more dangerous driving and risk taking in simulated driving conditions than females.

Adolescent↗