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Multicenter Study
. 2024 Aug 16;95(9):833-837.
doi: 10.1136/jnnp-2024-333505.

Implications for driving based on the risk of seizures after ischaemic stroke

Kai Michael Schubert  1 , Giulio Bicciato  1 , Lucia Sinka  1   2 , Laura Abraira  3 , Estevo Santamarina  3 , José Álvarez-Sabín  3 , Carolina Ferreira-Atuesta  4   5 , Mira Katan  1   6 , Natalie Scherrer  1 , Robert Terziev  1 , Nico Döhler  7   8 , Barbara Erdélyi-Canavese  7 , Ansgar Felbecker  7 , Philip Siebel  7 , Michael Winklehner  9 , Tim J von Oertzen  9 , Judith N Wagner  9   10 , Gian Luigi Gigli  11 , Annacarmen Nilo  11 , Francesco Janes  11 , Giovanni Merlino  11 , Mariarosaria Valente  11 , María Paula Zafra-Sierra  12 , Luis Carlos Mayor-Romero  12 , Julian Conrad  13   14 , S Evers  13   15 , Piergiorgio Lochner  16 , Frauke Roell  16 , Francesco Brigo  17 , Carla Bentes  18 , Rita Peralta  18 , Teresa Pinho E Melo  18 , Mark R Keezer  19   20 , John Sidney Duncan  4 , Josemir W Sander  4   19   21 , Barbara Tettenborn  7 , Matthias Koepp  4 , Marian Galovic  22   4
Affiliations
Multicenter Study

Implications for driving based on the risk of seizures after ischaemic stroke

Kai Michael Schubert et al. J Neurol Neurosurg Psychiatry. .

Abstract

Background: In addition to other stroke-related deficits, the risk of seizures may impact driving ability after stroke.

Methods: We analysed data from a multicentre international cohort, including 4452 adults with acute ischaemic stroke and no prior seizures. We calculated the Chance of Occurrence of Seizure in the next Year (COSY) according to the SeLECT2.0 prognostic model. We considered COSY<20% safe for private and <2% for professional driving, aligning with commonly used cut-offs.

Results: Seizure risks in the next year were mainly influenced by the baseline risk-stratified according to the SeLECT2.0 score and, to a lesser extent, by the poststroke seizure-free interval (SFI). Those without acute symptomatic seizures (SeLECT2.0 0-6 points) had low COSY (0.7%-11%) immediately after stroke, not requiring an SFI. In stroke survivors with acute symptomatic seizures (SeLECT2.0 3-13 points), COSY after a 3-month SFI ranged from 2% to 92%, showing substantial interindividual variability. Stroke survivors with acute symptomatic status epilepticus (SeLECT2.0 7-13 points) had the highest risk (14%-92%).

Conclusions: Personalised prognostic models, such as SeLECT2.0, may offer better guidance for poststroke driving decisions than generic SFIs. Our findings provide practical tools, including a smartphone-based or web-based application, to assess seizure risks and determine appropriate SFIs for safe driving.

Keywords: Activities of Daily Living; CLINICAL NEUROLOGY; EPILEPSY; STROKE.

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Conflict of interest statement

Competing interests: LA has received personal fees and travel support from UCB Pharma, Eisai, Esteve and Bial and personal fees from Sanofi outside the submitted work. ES has received grants and personal fees from UCB Pharma, Eisai, Esteve and Bial, outside the submitted work. SE received honoraria for consulting and lectures from Allergan/Abbvie, Lilly, Lundbeck, Novartis, Perfood, Teva (past 3 years). FB received fees and travel support from Lusofarmaco, outside the submitted work. CB received a Grant from Sociedade Portuguesa do AVC (sponsored by Tecnifar), honoraria for lectures and support for scientific events from Bial, outside the submitted work. MK received non-financial support from ROCHE and BRAHMS Thermofisher Scientific outside the submitted work. MRK reports grants from UCB and Eisai, outside of the submitted work. BT reports personal fees from Biogen outside the submitted work. JWS reports grants and personal fees from UCB, grants from NIHR and Angelini; and personal fees from UCB and Angelini outside the submitted work. MG received fees and travel support from Arvelle, Advisis, Bial and Nestlé Health Science outside the submitted work. JNW received fees from Boehringer Ingelheim and UCB and travel grants from ROCHE, outside the submitted work. TJvO reports personal fees from Angelini Pharma Österreich; Arvelle Therapeutics, Argenx, Biogen, Eisai GesmbH, GW Pharma, Jazz Pharmaceuticals, LivaNova, und von Zogenix, grants from Boehringer-Ingelheim, outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Private driving: impact of different SeLECT2.0 score values and seizure-free intervals (SFI) on the chance of an occurrence of a seizure in the next year: (A) The impact of different SFI on the chance of an occurrence of a seizure in the next year (COSY) following ischaemic stroke. The lines represent different SeLECT2.0 scores. (B) The numerical estimates of COSY stratified by different SFIs and SeLECT2.0 values including the 95% CIs. Colours suggested by different approaches by Bonnett et al and Marson (acceptable range of risk for private driving for COSY of 20%–40% suggested by Schmedding et al 6): risk estimates ≥20% (and lower CI≥20%) in red (=‘permissive approach’); risk estimates <20% (and higher CI<20%) in green (=‘conservative approach’) in orange and yellow: orange when risk estimate ≥20% but lower CI<20% (=‘liberal approach’); yellow when risk estimate <20% but upper CI>20% (=‘intermediate approach’).
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