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

Humans Epilepsy / diagnosis Electroencephalography Video Games Probability Odds Ratio

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
29 08 2023
Historique:
received: 09 05 2022
accepted: 04 05 2023
medline: 31 8 2023
pubmed: 7 7 2023
entrez: 6 7 2023
Statut: ppublish

Résumé

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. Patients with various epilepsies were evaluated with simultaneous EEGs during their response to visual stimuli in a single-flash test, a car-driving video game, and a realistic driving simulator. Reaction times (RTs) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered in this study, 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 (OR) of miss/crash due to IEDs were calculated. Generalized typical IEDs prolonged RT by 164 ms, compared with generalized atypical IEDs (77.0 ms) and focal IEDs (48.0 ms) ( 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 an RT prolongation of 90.3 ms as a clinically relevant IED effect. The IED-associated OR 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.

Sections du résumé

BACKGROUND AND OBJECTIVES
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 video game, and a realistic driving simulator. Reaction times (RTs) and missed reactions or crashes (miss/crash) during normal EEG and IEDs were measured. IEDs, as considered in this study, 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 (OR) of miss/crash due to IEDs were calculated.
RESULTS
Generalized typical IEDs prolonged RT by 164 ms, compared with generalized atypical IEDs (77.0 ms) and focal IEDs (48.0 ms) (
DISCUSSION
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 an RT prolongation of 90.3 ms as a clinically relevant IED effect. The IED-associated OR 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.

Identifiants

DOI: 10.1212/WNL.0000000000207531 PMID: 37414567 PMC: PMC10501101
pubmed: 37414567
pii: WNL.0000000000207531
doi: 10.1212/WNL.0000000000207531
pmc: PMC10501101
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e866-e878

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

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Auteurs

Heinz Krestel (H)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway. heinz.krestel@yale.edu.
ORCID: 0000-0001-8742-0232

David R Schreier (DR)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.
ORCID: 0000-0001-6088-2015

Elmaze Sakiri (E)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Andreas von Allmen (A)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Yasmina Abukhadra (Y)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Arto Nirkko (A)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Maja Steinlin (M)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Felix Rosenow (F)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.
ORCID: 0000-0002-3989-7471

Rune Markhus (R)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Gaby Schneider (G)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Caroline Jagella (C)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

Johannes Mathis (J)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.
ORCID: 0000-0002-3422-2715

Hal Blumenfeld (H)

From the Departments of Neurology (H.K., Y.A., C.J., H.B.), Neuroscience (H.B.), and Neurosurgery (H.B.), Yale School of Medicine, New Haven, CT; Epilepsy Center Frankfurt Rhine-Main (H.K., F.R.), University Hospital Frankfurt, Center for Personalized Translational Epilepsy Research (CePTER), and Institute of Mathematics (G.S.), Department of Computer Science and Mathematics, Goethe University, Frankfurt, Germany; Department of Neurology (D.R.S., A.N., J.M.); Departments of Cardiology (E.S.) and Pediatric Neurology (M.S.), Bern University Hospital and University of Bern; Neurocenter Lucerne (A.N.), Switzerland; and National Centre for Epilepsy (R.M.), Division of Clinical Neuroscience Oslo University Hospital, Norway.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Predictive Power of Interictal Epileptiform...
questionsmedicales.fr › Maladies du système nerveux › Maladies du système nerveux central › Encéphalopathies › Épilepsie › Predictive Power of Interictal Epileptiform...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Électrodiagnostic › Électroencéphalographie › Predictive Power of Interictal Epileptiform...
questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Logiciel › Jeux vidéo › Predictive Power of Interictal Epileptiform...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Predictive Power of Interictal Epileptiform...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Odds ratio › Predictive Power of Interictal Epileptiform...