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

Rhys H Thomas (1) , Will H King (2) , Ann Johnston (1) , Philip Em Smith (3)

1 Wales Epilepsy Research Network, Institute of Life Sciences, Swansea University, Singleton Park
2 3. National Public Health Service, Mamhilad Park Estate, Pontypool, Gwent, NP9 0YP
3 Department of Neurology, University Hospital of Wales, Heath Park, Cardiff

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 (D'Alessandro 2004), we could 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%), relative risk (RR) 1.3. European licensing bodies including the UK's Driver and Vehicle Licensing Agency broadly accept an RR of <2.0 for Group 1 licensing. However this study excluded patients with frontal lobe epilepsies. Furthermore, follow-up (n=160) varied from 2–6 years, yet new awake seizures may occur even after 10–20 years of pure sleep-related epilepsy A paucity of evidence underpins present licensing law; current rulings would be difficult to defend if legally challenged. The law may be both penalising people with pure sleep-related epilepsy without increased risk of awake seizures, whilst failing to identify subgroups at unacceptable risk of an awake seizure at the wheel.

Mots clés: EPILEPSY; SLEEP

Rhys H Thomas, Will H King, Ann Johnston, Philip Em Smith. Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 81 (2), pp.130. ⟨10.1136/jnnp.2009.181438⟩. ⟨hal-00552789⟩