[Research on the effects of the new antihistaminic Ambodryl on driving fitness].
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OBJECTIVE: To examine the frequency of driving an automobile and characteristics associated with driving in individuals with refractory localization-related epilepsy. BACKGROUND: Driving is generally restricted and monitored in people with epilepsy. Little is known about the frequency of driving and subsequent accidents specifically in individuals with uncontrolled epilepsy. METHODS: In an ongoing, prospective, multicenter study of resective epilepsy surgery, individuals were interviewed when they presented for surgical evaluation. Analyses were conducted using chi-square, t-tests, and multiple logistic regression. RESULTS: Of 367 eligible participants, 115 (31.3%) had driven in the last year, most on at least a weekly basis. In a multivariable analysis, factors associated with an increased likelihood of driving were having a current license (OR = 10.71, p < 0.001) and ever having had a license (OR = 3.86, p = 0.003). Younger individuals were also more likely to drive. Lower levels of driving were found in women (OR = 0.31, p < 0.001), individuals who were self-described as disabled (OR = 0.20, p < 0.001), and those who were employed full-time (OR = 0.43, p = 0.03) or part-time (OR = 0.15, p = 0.005). At some point in the past, 144 individuals experienced one or more seizures while driving, and 98 experienced at least one accident because of a seizure. Of those who had accidents, 94% reported property damage, 32% had an injury, and 20% caused injury to others. CONCLUSION: Despite restrictions, almost one third of individuals with refractory epilepsy drive. Understanding why they do may help identify means of modifying this behavior or identifying services that, if provided, would help people with uncontrolled epilepsy forego driving.
Automobile accidents occurred with 55% of seizures in epileptic drivers with both well-described seizures at the wheel and a well-classified epilepsy diagnosis. A further 38% of seizures would have led to accidents in less fortunate settings. Complex partial seizures occurred in 81% of patients and were responsible for 88% of accidents. Immediate alterations of consciousness were significantly more likely to lead to accidents than were seizures beginning with an aura. Motor activity during simple partial seizures was also responsible for some accidents. Differences in seizure frequency may account for different crude accident rates among studies of epileptic drivers. We suggest guidelines for licensing restrictions that seem safe and reasonable.
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From results of a survey of 72 epileptic car drivers who had a mean driving history of 8.6 years, 18 (25%) had experienced one or more automobile accidents ascribed to a seizure while driving, with the total number of accidents of the surveyed group amounting to 35. All the drivers were known to have partial epilepsy, 13 of them having temporal lobe epilepsy. The main characteristics of these 35 accidents were as follows: (1) Fifty-seven percent were caused by complex partial seizure without an aura in which consciousness was immediately impaired at onset, while about 10% were attributed to simple partial seizure in which the conscious state was not altered. No accident was caused by a first seizure; (2) Fifty-one percent occurred on an empty road with little pedestrian and/or vehicular traffic; (3) In about half the accidents, the driver's vehicle collided against an immovable object, and only 20% involved crashing into another car; (4) Most accidents caused damage to only the driver's car and/or mild physical injury; and (5) Fifty-four percent of the accidents were not reported to the police, and many that were reported were ascribed to driving while asleep, to careless driving or to similar behavior.
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