A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games

Patients with epilepsy are at risk of traffic accidents when they have seizures while driving. However, driving is an essential part of normal daily life in many communities, and depriving patients of driving privileges can have profound consequences for their economic and social well-being. In the current study, we collected ictal performance data from a driving simulator and two other video games in patients undergoing continuous video/EEG monitoring. We captured 22 seizures in 13 patients and found that driving impairment during seizures differed in terms of both magnitude and character, depending on the seizure type. Our study documents the feasibility of a prospective study of driving and other behaviors during seizures through the use of computer-based tasks. This methodology may be applied to further describe differential driving impairment in specific types of seizures and to gain data on anatomical networks disrupted in seizures that impair consciousness and driving safety.

[1]  Matthew N. DeSalvo,et al.  Dynamic Time Course of Typical Childhood Absence Seizures: EEG, Behavior, and Functional Magnetic Resonance Imaging , 2010, The Journal of Neuroscience.

[2]  Oliver Granert,et al.  Changes in activity of striato–thalamo–cortical network precede generalized spike wave discharges , 2008, NeuroImage.

[3]  Jason Freeman,et al.  Selective frontal, parietal, and temporal networks in generalized seizures , 2003, NeuroImage.

[4]  G Li,et al.  Risk factors for seizure-related motor vehicle crashes in patients with epilepsy , 1999, Neurology.

[5]  J. VanBuren,et al.  ON THE NATURE OF THE "ABSENCE" IN CENTRENCEPHALIC EPILEPSY: A STUDY OF SOME BEHAVIORAL, ELECTROENCEPHALOGRAPHIC AND AUTONOMIC FACTORS. , 1965, Electroencephalography and clinical neurophysiology.

[6]  Eleanor A. Maguire,et al.  Neural substrates of driving behaviour , 2007, NeuroImage.

[7]  Josemir W Sander,et al.  Epilepsy and driving , 2005, BMJ : British Medical Journal.

[8]  G. Krauss,et al.  Mortality in epilepsy , 2004, Neurology.

[9]  Hal Blumenfeld,et al.  Theories of Impaired Consciousness in Epilepsy , 2009, Annals of the New York Academy of Sciences.

[10]  J. Taylor,et al.  Risk of accidents in drivers with epilepsy. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[11]  Joshua E. Motelow,et al.  Cortical and subcortical networks in human secondarily generalized tonic-clonic seizures. , 2009, Brain : a journal of neurology.

[12]  H. Siebner,et al.  Simultaneous EEG‐fMRI in drug‐naive children with newly diagnosed absence epilepsy , 2008, Epilepsia.

[13]  G. Tononi,et al.  The neurology of consciousness : cognitive neuroscience and neuropathology , 2009 .

[14]  H. Blumenfeld Consciousness and epilepsy: why are patients with absence seizures absent? , 2005, Progress in brain research.

[15]  J D Dawson,et al.  Predictors of driving safety in early Alzheimer disease , 2009, Neurology.

[16]  E. Maguire,et al.  Navigation around London by a taxi driver with bilateral hippocampal lesions. , 2006, Brain : a journal of neurology.

[17]  L. Johnson,et al.  PAROXYSMAL EEG ACTIVITY AND COGNITIVE-MOTOR PERFORMANCE. , 1964, Electroencephalography and clinical neurophysiology.

[18]  C. Tassinari,et al.  [Variations in the efficiency level in relation to paroxysmal epileptic discharges]. , 1965, Revue neurologique.

[19]  G. Baker,et al.  Perceived impact of epilepsy in teenagers and young adults: An international survey , 2008, Epilepsy & Behavior.

[20]  J. Sirven,et al.  Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: How are we doing? , 2009, Epilepsy & Behavior.

[21]  M. Sperling,et al.  Auras and subclinical seizures: Characteristics and prognostic significance , 1990, Annals of neurology.

[22]  S. Broste,et al.  The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. , 1991, The New England journal of medicine.

[23]  Cheng Luo,et al.  EEG–fMRI study on the interictal and ictal generalized spike-wave discharges in patients with childhood absence epilepsy , 2009, Epilepsy Research.

[24]  J. Gotman,et al.  Generalized epileptic discharges show thalamocortical activation and suspension of the default state of the brain. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[25]  de Dick Waard,et al.  Proceedings 3rd International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design , 2008 .

[26]  L. Goldie,et al.  Spike and Wave Discharges and Alterations of Conscious Awareness , 1961, Nature.

[27]  J. Pekar,et al.  Different activation dynamics in multiple neural systems during simulated driving , 2002, Human brain mapping.

[28]  H. Blumenfeld,et al.  Consciousness and epilepsy: why are complex-partial seizures complex? , 2009, Progress in brain research.

[29]  H. Gastaut,et al.  The risk of automobile accidents with seizures occurring while driving , 1987, Neurology.

[30]  J. Pekar,et al.  Alcohol Intoxication Effects on Simulated Driving: Exploring Alcohol-Dose Effects on Brain Activation Using Functional MRI , 2004, Neuropsychopharmacology.

[31]  Colin Studholme,et al.  Positive and negative network correlations in temporal lobe epilepsy. , 2004, Cerebral cortex.

[32]  J. Pekar,et al.  Erratum: Different activation dynamics in multiple neural systems during simulated driving (Human Brain Mapping (2002) 16 (158-167)) , 2002 .

[33]  W. Hauser,et al.  Driving and epilepsy. A review and reappraisal. , 1991, JAMA.

[34]  Janelle L. Wagner,et al.  Psychosocial factors associated with stigma in adults with epilepsy , 2009, Epilepsy & Behavior.

[35]  J. Phemister Epilepsy and car-driving. , 1961, Lancet.

[36]  Hal Blumenfeld,et al.  Why do Seizures Cause Loss of Consciousness? , 2003, The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry.

[37]  D. Spencer,et al.  Ictal neocortical slowing in temporal lobe epilepsy , 2004, Neurology.

[38]  Matthew N. DeSalvo,et al.  Cortical Deactivation Induced by Subcortical Network Dysfunction in Limbic Seizures , 2009, The Journal of Neuroscience.

[39]  J. A. Waller Chronic medical conditions and traffic safety: review of the California experience. , 1965, The New England journal of medicine.