Driving impairment caused by episodic brain dysfunction. Restrictions for epilepsy and syncope.

The potential loss of driving privileges is a major concern of patients with epilepsy and other episodic brain illness. The extreme variation from state to state in reporting requirements and the duration of restrictions illustrate the legal ramifications of uncertain medical advice. We studied the reliability of various methods of predicting recurrences, including electroencephalograms, familial data, and epidemiologic data and concluded that we should offer more flexible, detailed guidelines. These ought to encourage regulators, colleagues, and patients and would perhaps increase highway safety through better compliance. Episodic changes in cognition unrelated to epilepsy or syncope remain a quagmire. When the most reliable risk factors are listed in tabular form, the result appears complex, but such a guideline should be fairer, easier to administer, and often more lenient than the present simplistic, arbitrary codes found in most states.

[1]  W. Kapoor,et al.  A prospective evaluation and follow-up of patients with syncope. , 1983, The New England journal of medicine.

[2]  G. Scambler,et al.  HOW DOCTORS DEAL WITH EPILEPSY , 1977, The Lancet.

[3]  F. Gibberd,et al.  Sleep Epilepsy: Its Pattern and Prognosis , 1974, British medical journal.

[4]  P. Harvey,et al.  VIEWS OF BRITISH NEUROLOGISTS ON EPILEPSY, DRIVING, AND THE LAW , 1983, The Lancet.

[5]  R. Duvoisin.  Covulsive syncope induced by the Weber maneuver. , 1962, Archives of neurology.

[6]  S. Glasser,et al.  Arrhythmias detected by ambulatory monitoring. Lack of correlation with symptoms of dizziness and syncope. , 1980, Chest.

[7]  W. Hauser,et al.  The Epidemiology of Epilepsy in Rochester, Minnesota, 1935 Through 1967 , 1975, Epilepsia.

[8]  E. Vining,et al.  Stopping medication in children with epilepsy: predictors of outcome. , 1981, The New England journal of medicine.

[9]  R. Masland.  The physician's responsibility for epileptic drivers , 1978, Annals of neurology.

[10]  B. Lown,et al.  Sudden cardiac death: the major challenge confronting contemporary cardiology. , 1979, The American journal of cardiology.

[11]  Fisher Cm,et al.  TRANSIENT GLOBAL AMNESIA. , 1964 .

[12]  W. Blume,et al.  Generalized sharp and slow wave complexes. Associated clinical features and long-term follow-up. , 1973, Brain : a journal of neurology.

[13]  E. FRANTZEN,et al.  PROTEIN STUDIES ON CEREBROSPINAL FLUID AND NEUROLOGICAL SYMPTOMS IN MYELOMATOSIS , 1969, Acta neurologica Scandinavica.

[14]  P. J. M. Lugt.  Traffic Accidents Caused by Epilepsy , 1975 .

[15]  E. Rodin,et al.  Epileptic patients who are refractory to anticonvulsant medications , 1982, Neurology.

[16]  K. Meador,et al.  Transient global amnesia , 1986, Neurology.

[17]  E. Michelson,et al.  Nonsustained ventricular tachycardia in ambulatory patients: characteristics and association with sudden cardiac death. , 1980, Annals of internal medicine.

[18]  M. Dam,et al.  Practical aspects in the treatment of epilepsy , 1983, Acta neurologica Scandinavica. Supplementum.

[19]  T. Pedley.  Differential Diagnosis of Episodic Symptoms , 1983, Epilepsia.

[20]  P. Juul‐Jensen.  Frequency of Recurrence after Discontinuance of Anti‐convulsant Therapy in Patients with Epileptic Seizures , 1964, Epilepsia.

[21]  T. Gibson,et al.  Diagnostic efficacy of 24-hour electrocardiographic monitoring for syncope. , 1984, The American journal of cardiology.

[22]  W. Oldendorf.  The Use and Promise of Nuclear Magnetic Resonance Imaging in Epilepsy , 1984, Epilepsia.

[23]  A. Crancer,et al.  Accident and Violation Rates of Washington's Medically Restricted Drivers , 1968 .

[24]  J. A. Gomes,et al.  Programmed electrical stimulation in patients with high-grade ventricular ectopy: electrophysiologic findings and prognosis for survival. , 1984, Circulation.

[25]  E F Cook,et al.  Evaluation and outcome of emergency room patients with transient loss of consciousness. , 1982, The American journal of medicine.

[26]  T. Ōkuma,et al.  Natural History and Prognosis of Epilepsy: Report of a Multi‐institutional Study in Japan , 1981, Epilepsia.

[27]  C. Warlow,et al.  Cardiac rhythm abnormalities in patients presenting with transient non-focal neurological symptoms: a diagnostic grey area? , 1982, British medical journal.

[28]  P. Jannetta,et al.  Trigeminal neuralgia associated with seizure and syncope. Case report. , 1984, Journal of neurosurgery.

[29]  D. Hossack.  MEDICAL CATASTROPHE AT THE WHEEL , 1980 .

[30]  L. Lipsitz.  The Drop Attack , 1983, Journal of the American Geriatrics Society.

[31]  F. Burg,et al.  Licensing the driver with alterations of consciousness. , 1970, Archives of neurology.

[32]  N. Sofijanov.  Clinical Evolution and Prognosis of Childhood Epilepsies , 1982, Epilepsia.

[33]  J. Lewis,et al.  Driving With Epilepsy: A Contemporary Perspective , 1983, Southern medical journal.

[34]  Penry Jk.  Diagnosis and treatment of absence seizures. , 1984, Cleveland Clinic quarterly.

[35]  The physician's duty to warn: a new twist. , 1984, Survey of ophthalmology.

[36]  H. G. Martin,et al.  Prospective evaluation of syncope. , 1984, Annals of emergency medicine.

[37]  S. Glasser,et al.  Occurrence of frequent complex arrhythmias detected by ambulatory monitoring: findings in an apparently healthy asymptomatic elderly population. , 1979, Chest.

[38]  C. Lai,et al.  Convulsive syncope in blood donors , 1982, Annals of neurology.

[39]  W. Steward,et al.  Prognosis of isolated seizures in adult life. , 1981, British medical journal.

[40]  L. Johnson,et al.  Diagnostic factors in adult males following initial seizures. A three-year follow-up. , 1972, Archives of neurology.

[41]  J. Kostis,et al.  Premature Ventricular Complexes in the Absence of Identifiable Heart Disease , 1981, Circulation.

[42]  M. Vekemans,et al.  Reciprocal translocation in small-cell sarcomas. , 1984, The New England journal of medicine.

[43]  W. Hauser,et al.  Seizure recurrence after a first unprovoked seizure. , 1982, The New England journal of medicine.

[44]  C. Plank,et al.  The pathology of drop attacks , 1979, Neurology.

[45]  H. Lüders,et al.  Differential diagnosis and treatment of intractable seizures. , 1984, Cleveland Clinic quarterly.

[46]  S. Sato,et al.  Serial EEG in intractable epilepsy , 1984, Neurology.

[47]  P. Taggart,et al.  Some effects of motor-car driving on the normal and abnormal heart , 1969, British medical journal.

[48]  L. Elveback,et al.  Seizures after head trauma , 1980, Neurology.

[49]  Julian A. Waller,et al.  Highway crash and citation patterns and chronic medical conditions , 1969 .

[50]  J. Morganroth.  Premature ventricular complexes. Diagnosis and indications for therapy. , 1984, JAMA.

[51]  G O Barnett,et al.  Patients with syncope admitted to medical intensive care units. , 1982, JAMA.

[52]  H. Kennedy,et al.  Effectiveness of increasing hours of continuous ambulatory electrocardiography in detecting maximal ventricular ectopy. Continuous 48 hour study of patients with coronary heart disease and normal subjects. , 1978, The American journal of cardiology.

[53]  H. Todt.  The Late Prognosis of Epilepsy in Childhood: Results of a Prospective Follow‐up Study , 1984, Epilepsia.

[54]  F. Dreifuss,et al.  Responsiveness before, during, and after spike‐wave paroxysms , 1974, Neurology.

[55]  C. Fisher.  Transient global amnesia. Precipitating activities and other observations. , 1982, Archives of neurology.

[56]  M. Sageshima,et al.  Long‐Term Prognosis on Recurrence of Seizures Among Children With Epilepsy After Drug Withdrawal‐Elimination , 1978, Folia psychiatrica et neurologica japonica.

[57]  E H Reynolds,et al.  The prognosis for seizure control in newly diagnosed epilepsy. , 1984, The New England journal of medicine.

[58]  D. Thurston,et al.  Prognosis in childhood epilepsy: additional follow-up of 148 children 15 to 23 years after withdrawal of anticonvulsant therapy. , 1982, The New England journal of medicine.

[59]  G. Klein,et al.  Undiagnosed syncope: search for an arrhythmic etiology. , 1982, Stroke.

[60]  J H Lacey,et al.  DRIVER ALCOHOL AND MEDICAL PROBLEMS , 1982 .

[61]  M. Saunders,et al.  Isolated Seizures: An EEG and Clinical Assessment , 1975, Epilepsia.

[62]  S. Bharati,et al.  Cardiac disease in sudden death. , 1984, Archives of internal medicine.

[63]  D. R. Gregory.  The physicians' role in highway safety--reporting requirements. , 1981, Legal medicine.

[64]  E. Goldensohn.  Symptomatology of Nonconvulsive Seizures: Ictal and Postictal , 1983, Epilepsia.