Realistic driving simulation during generalized epileptiform discharges to identify electroencephalographic features related to motor vehicle safety: Feasibility and pilot study

Abstract

Objective: Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. Methods: Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs.Results: Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 μV vs 52.99 μV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). Significance: High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk. K E Y W O R D Sabsence seizures, consciousness, driving, EEG, epilepsy, spike-wave discharges 20 | COHEN Et al.

Spatiotemporal dynamics between interictal epileptiform discharges and ripples during associative memory processing

“…IEDs have prolonged reaction times in a driving simulation task (Krestel et al, 2011;Nirkko et al, 2016), and increased crash rate when virtual obstacle is presented (Nirkko et al, 2016) IEDs prolonged reaction time in a variable manner, with generalized discharges affecting RT greater than focal discharges (Nirkko et al, 2016); and longer and higher voltage IEDs exerting a greater effect (Cohen et al, 2020).…”

Simulated driving in the epilepsy monitoring unit: Effects of seizure type, consciousness, and motor impairment

“…The simulator we used reflected typical driving conditions, where severely impaired driving behaviors or collisions would be detected, but more subtle deficits might be missed. Methods with sudden unexpected obstacles coinciding with epileptiform activity can detect delayed reaction times or other subtle deficits in driving, which we may have missed here 8,15,17 . This may be particularly true for GSWs (including slow spike–wave), where we rarely found deficits with the current approach, whereas more instantaneous testing methods are capable of uncovering deficits 8,11,15,17 .…”

Pearls & Oy-sters: Driving Safety in Photosensitive Genetic Generalized Epilepsy

“…Many studies have shown that with better clinical testing, transitory cognitive impairment, manifest most commonly as increased reaction time, accompanies these seemingly subclinical discharges. [1][2][3][4] In early experiments from the 1940s, the discharge bursts lasting 1-3 seconds had normal reaction times, and longer bursts showed impairment. 1 Nevertheless, some other studies showed an increase in reaction time even with short bursts lasting 0.5-1.5 seconds; however, there was no increase in errors of omission during such short bursts.…”

“…This pilot study showed that generalized spike-wave discharges with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, p < 0.001). 4 Again, the study had a low sample size of 9 although 88 bursts were studied. Although the data regarding this are limited, as discussed above, there is a suggestion of correlation of transitory cognitive impairment with duration of generalized spike-wave bursts.…”

“…[1][2][3][4] Increased reaction time is the most sensitive behavioral correlate to these discharges. 3,4 c Duration of generalized spike-wave discharges is a likely determinant of increased reaction time and cognitive impairment. Discharges longer than 2-3 seconds are associated with increased reaction time, 1,3,4 and these may imply the necessity for further evaluation of driving ability.…”