EEG in fitness to drive evaluations in people with epilepsy — Considerable variations across Europe

Markhus, Rune; Henning, Oliver; Molteberg, Ellen; Hečimović, Hrvoje; Újvári, Ákos; Hirsch, Édouard; Rheims, Sylvain; Surges, Rainer; Malmgren, Kristina; Rüegg, Stephan; Gil‐Nagel, Antonio; Roivainen, Reina; Picard, Fabienne; Steinhoff, Bernhard J.; Marusič, Petr; Mostacci, Barbara; Kimiskidis, Vasilios Κ.; Mı̂ndruță, Ioana; Jagella, Caroline; Mameniškienė, Rūta; Schulze‐Bonhage, Andreas; Rosenow, Felix; Kelemen, Anna; Fabó, Dániel; Walker, Matthew C.; Seeck, Margitta; Arsene, Oana Tarta; Krestel, Heinz; Lossius, Morten I.

doi:10.1016/j.seizure.2020.04.013

Cited by 3 publications

(2 citation statements)

References 13 publications

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“… 20 , 21 A recent survey of European epileptologists revealed varying opinions on the use of EEG and the consideration of IEDs for fitness-to-drive evaluation. 22 However, there was consensus (>80%) on the need for more research to improve evaluation techniques and for coordination and regulation of best practices for evaluating fitness to drive. 22 Existing evaluation techniques include a flash test that is used by several epilepsy centers to examine IED effects on responsiveness.…”

Section: Introductionmentioning

confidence: 99%

“… 22 However, there was consensus (>80%) on the need for more research to improve evaluation techniques and for coordination and regulation of best practices for evaluating fitness to drive. 22 Existing evaluation techniques include a flash test that is used by several epilepsy centers to examine IED effects on responsiveness. A recent pilot study using a realistic driving simulator demonstrated the feasibility of a simulator to test the effects of generalized epileptiform discharges on driving performance.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation

Krestel,

Schreier,

Sakiri

et al. 2023

Neurology

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation

Krestel,

Schreier,

Sakiri

et al. 2023

Neurology

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Electroencephalographic compatibility with fitness to drive: A nationwide survey among Swiss neurologists

Spöndlin,

Hardmeier,

Sutter

et al. 2024

Epilepsia Open

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ObjectiveThe Swiss guidelines for driving with epilepsy require that electroencephalogram (EEG) findings must be compatible with the fitness to drive (FTD) without specifying any criteria. This nationwide survey investigated how Swiss neurologists implement this requirement in clinical practice.MethodsAn online survey, including 19 EEG examples and statements about the compatibility of the EEG with FTD, was distributed to all members of the Swiss Society of Clinical Neurophysiology and all Swiss neurological clinics with residency programs. Descriptive statistics and Fleiss' Kappa for inter‐rater agreement were performed.Results102 participants (37% female, 45% <45 years) completed the survey, with 15% primarily working in a specialized epileptology center (EPI), 55% in a hospital setting without epileptological focus (HOS), and 30% in private practice (PP). Most participants of all three groups regarded EEG normal variants as compatible with FTD, while hyperventilation‐induced rhythmic slowing and some pathological patterns (e.g., frontal and temporal intermittent rhythmic delta activity [FIRDA, TIRDA], focal interictal epileptiform discharges [IED], focal seizure) were evaluated more heterogeneously. The EEG inter‐rater agreement for EPI was 0.4; 0.31 for PP; and 0.24 for HOS. No consensus was found for acceptable duration for generalized or focal IEDs. Among all participants, evaluation by an epilepsy center (85%) and reaction‐time testing (67%) were evaluated as the most useful additional examinations. However, reaction‐time testing is rarely or never performed by 58%. Most supported EEG results as part of the FTD assessment and demanded more research (both 82%).SignificanceOur survey indicates considerable heterogeneity among Swiss neurologists when evaluating the EEG findings for FTD. Inter‐rater agreement in all three groups was fair, with highest agreement among epileptologists. We noted a discrepancy between the usefulness and actual application of reaction‐time testing. More training and research are warranted to achieve rater‐independent consistency for FTD evaluation.Plain Language SummaryIn Switzerland, neurologists must consider the findings from EEG (brain waves) exams to evaluate driving safety in people with epilepsy. We surveyed Swiss neurologists, asking their opinions on this matter. We found that opinions differ among individual doctors, with the highest agreement among epilepsy specialists. We also found that some additional tests, such as reaction‐time testing, are perceived as useful but are rarely performed. The participating neurologists supported considering EEG results for driving fitness assessments but favored more precise guidelines and research.

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Under-sampling in epilepsy: Limitations of conventional EEG

Baud

Schindler

Rao

2021

Clinical Neurophysiology Practice

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EEG in fitness to drive evaluations in people with epilepsy — Considerable variations across Europe

Cited by 3 publications

References 13 publications

Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation

Predictive Power of Interictal Epileptiform Discharges in Fitness-to-Drive Evaluation

Electroencephalographic compatibility with fitness to drive: A nationwide survey among Swiss neurologists

Under-sampling in epilepsy: Limitations of conventional EEG

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