Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation.
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BORIS DOI
Publisher DOI
PubMed ID
37414567
Description
BACKGROUND
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 videogame, and a realistic driving simulator. Reaction times (RT) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered here, 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 of miss/crash due to IEDs were calculated.
RESULTS
Generalized typical IEDs prolonged RT by 164ms, compared to generalized atypical IEDs (77.0ms) and focal IEDs (48.0ms) (p<0.01). Generalized typical IEDs had a session miss/crash probability of 14.7% compared to a zero median for focal and generalized atypical IEDs (p<0.01). Long repetitive bursts of focal IEDs lasting >2s had a 2.6% miss/crash probabilityIED. Cumulated miss/crash probability could be predicted from RT-prolongation: 90.3ms yielded a 20% miss/crash probability. All tests were non-superior to each other in detecting miss/crash probabilitiesIED (zero median for all three tests) or RT-prolongations (flash test: 56.4ms, car-driving videogame: 75.5ms, simulator 86.6ms). IEDs increased the odds ratio (OR) of miss/crash in the simulator by 4.9-fold compared to normal EEG. A table of expected RT-prolongations and miss/crash probabilities for IEDs of a given type and duration was created.
CONCLUSION
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 a RT-prolongation of 90.3ms as a clinically relevant IED effect. The IED-associated odds ratio 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.
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 videogame, and a realistic driving simulator. Reaction times (RT) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered here, 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 of miss/crash due to IEDs were calculated.
RESULTS
Generalized typical IEDs prolonged RT by 164ms, compared to generalized atypical IEDs (77.0ms) and focal IEDs (48.0ms) (p<0.01). Generalized typical IEDs had a session miss/crash probability of 14.7% compared to a zero median for focal and generalized atypical IEDs (p<0.01). Long repetitive bursts of focal IEDs lasting >2s had a 2.6% miss/crash probabilityIED. Cumulated miss/crash probability could be predicted from RT-prolongation: 90.3ms yielded a 20% miss/crash probability. All tests were non-superior to each other in detecting miss/crash probabilitiesIED (zero median for all three tests) or RT-prolongations (flash test: 56.4ms, car-driving videogame: 75.5ms, simulator 86.6ms). IEDs increased the odds ratio (OR) of miss/crash in the simulator by 4.9-fold compared to normal EEG. A table of expected RT-prolongations and miss/crash probabilities for IEDs of a given type and duration was created.
CONCLUSION
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 a RT-prolongation of 90.3ms as a clinically relevant IED effect. The IED-associated odds ratio 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.
Date of Publication
2023-08-29
Publication Type
Article
Subject(s)
Language(s)
en
Contributor(s)
Kreste, Heinz | |
Sakiri, Elmaze | |
von Allmen, Andreas | |
Abukhadra, Yasmina | |
Rosenow, Felix | |
Markhus, Rune | |
Schneider, Gaby | |
Jagella, Caroline | |
Blumenfeld, Hal |
Additional Credits
Series
Neurology
Publisher
American Academy of Neurology
ISSN
1526-632X
Access(Rights)
open.access