Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 81; no. 2; pp. 130 - 135
• Main Authors: Thomas, R H, King, W H, Johnston, J A, Smith, P E M
• Format: Journal Article Book Review
• Language: English
• Published: London BMJ Publishing Group Ltd 01-02-2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Accidents, Traffic - statistics & numerical data; Anticonvulsants - therapeutic use; Automobile Driving - legislation & jurisprudence; Automobile Driving - statistics & numerical data; awake; Biological and medical sciences; driving; epilepsy; Epilepsy, Frontal Lobe - drug therapy; Epilepsy, Frontal Lobe - epidemiology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; nocturnal; Risk Factors; Seizures - drug therapy; Seizures - epidemiology; Sleep; Systematic review; Time Factors; United Kingdom - epidemiology; Wakefulness; Nervous system diseases; Sleep; Convulsion; Epilepsy; Central nervous system disease; Sleep wake cycle; Neurological disorder; Cerebral disorder; SLEEP; EPILEPSY
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2009.181438

Who with sleep seizures is safe to drive? Driving law is controversial; ineligibility varies between individual US states and EU countries. Current UK driving law is strongly influenced by a single-centre study from 1974 where most participants were not taking antiepileptic drugs (AEDs). However, pure sleep-related epilepsy is often fully controlled on medication, and its withdrawal can provoke awake seizures.This systematic review asked, ‘What is the risk of awake seizures in pure sleep-related epilepsy?’ 9885 titles were identified; 2312 were excluded (not human or adult); 40 full texts were reviewed; six papers met our inclusion criteria; each of these six studies had a different pure sleep-related epilepsy definition.Using the largest prospective study, we were able to calculate next year's awake seizure chance (treated with antiepileptic medication). This was maximal in the second year: 5.7% (95% CI 3.0 to 10.4%). European licensing bodies including the UK's Driver and Vehicle Licensing Agency broadly accept a risk of less than 20% for Group 1 licensing. However, this study excluded patients with frontal-lobe epilepsies. Furthermore, follow-up (n=160) varied from 2 to 6 years, yet new awake seizures may occur even after 10–20 years of pure sleep-related epilepsyA paucity of evidence underpins present licensing law; current rulings would be difficult to defend if legally challenged. The law may be penalising people with pure sleep-related epilepsy without increased risk of awake seizures, while failing to identify subgroups at unacceptable risk of an awake seizure at the wheel.