1. Implications for driving based on the risk of seizures after ischaemic stroke.
- Author
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Schubert KM, Bicciato G, Sinka L, Abraira L, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Terziev R, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Mayor-Romero LC, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta R, Pinho E Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp M, and Galovic M
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Risk Factors, Aged, 80 and over, Prognosis, Cohort Studies, Adult, Automobile Driving, Seizures etiology, Seizures complications, Ischemic Stroke complications
- 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 SeLECT
2.0 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., Competing Interests: 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., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
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