Download - DRIVING AND NEUROLOGICAL DISORDERS
DRIVING IN NEUROLOGICLAL
DISORDERS
Prof. Ashraf AbdouNeuropsychiatry department
Alexandria university
OBJECTIVES
Mechanism of driving impairment
Driving in Epilepsy
Driving in Dementia
Driving in Parkinson’s D.
Driving after stroke
WHO 2012
WHO 2012
Driving
Higher cognitive functions
Perception and attention to stimulus
Formulation of a plan based on memory experiences
Execution of an action such as applying a brake,
steering control, or accelerator
Vision
motor control and coordination.
Neurological impairment & Paroxysmal disorders
Neurological impairmentParoxysmal loss of awareness
Cognitive impairment - AD EPILEPSY
Motor control impairment
# Weakness
# Bradykinesia
# Incoordination
Excessive day –time sleepiness/sleep disorders
Acute hypoglycemia
Syncope# Arrythmia# Dysautonomia
Drazkowski J F , and Sirven J I Neurology 2011;76:S44-S49© 2013 American Academy of Neurology
USA current position for doctor responsibility
Pros & Cons on reporting
Patient’s safety
Community safety
Doctor-patient
confidentiality
Patient conceal
medical information
that help in treatment
Patient’s right
Epilepsy
Studies showedApproximately 700,000 of the 180 million1 Americans
licensed to drive have epilepsy Drivers with well-controlled seizures are not at a high or
unacceptable risk for crashesuncontrolled epilepsy poses a substantial risk for MVA50% patients who have seizures while driving have
motor vehicle crashesOne recent US study showed that patients with
intractable seizures often continue driving. 39% had a seizure at the wheel27% crashed because of a seizure
Evidence-based
Not predictive of motor vehicle crash (MVC).
protective against crashes
Short seizure-free intervals (≥ 3 months) (Level C)
Epilepsy surgery (Level B),
Seizure-free intervals (6–12 months) (Level B)
Few prior non-seizure-related crashes (Level B)
Regular antiepileptic drug adjustments (Level B)
Epilepsy Behav. 2012 Feb;23(2):103-12
Risk of driving in medical diseases
Seizure-free period & Driving
Most European countries; 1 yr seizure-free
In USA: AAN – AES –EFA; 3 months
3 months (7 states), 6 months (14 states), and
1yr (7 states)
23 state no specific time [Neurologist – MAB]
7 states mandatory physician reporting
In Japan: 1 yr seizure-free
Figure. Seizure-free restrictions for noncommercial driving in the United States.
Krauss G et al. Neurology 2001;57:1780-1785
Copyright © 2012 British Epilepsy Association Terms and Conditions
Drazkowski J F , and Sirven J I Neurology 2011;76:S44-S49© 2013 American Academy of Neurology
USA current position for doctor responsibility
# The official position of the AMA. AES, AAN do not support mandatory
reporting of medical conditions to government
# Most European medical societies took a position against physician
reporting
F A V O U R A B L E
U N F A V O U R A B L E
Seizure-freeOff medication
USA: 10 yrs EU: 5 yrs
ONLY IN EGYPT
Dementia
Dementia and driving
Patients with mild AD showed double car
crash in age-matched controls.
The average number of crashes per year in
patients with AD increased dramatically after
the first 3 years from symptom onset.
75% can pass on-road driving
Evidence-Based : patients at increased risk for unsafe driving
FactorLevel of evidence
Clinical Dementia Rating Scale [CDR] AA caregiver's rating of a patient's driving ability as
marginal or unsafe
C
A history of traffic citations CA history of crashes CReduced driving mileage CSelf-reported situational avoidance CMMSE scores of ≤24 CAggressive or impulsive personality characteristic C
AAN Practice Parameter update: Evaluation and management of driving risk in dementia 2010
Drazkowski J F , and Sirven J I Neurology 2011;76:S44-S49© 2013 American Academy of Neurology
Stroke
Driving after stroke
In developed countries, more than half of persons with stroke are fit to drive following a successful on-road examination
Most reliable test for recognition of resuming driving after stroke:
Road Sign Recognition test
Trail making test B
Compass task
Cube copy test
Stroke Drivers Screening Assessment
Parkinson’s Disease
Parkinson disease (PD):Typical motor symptoms Cognitive impairment/dementiaEmotional impairments (e.g., apathy and
disinhibition) Visual-perceptual deficitsPossible side effects (e.g., daytime
sleepiness) of PD medications
Parkinson’s D & driving
A retrospective survey study: found that patients with Hoehn & Yahr (H&Y) stages 2 and 3 had a significantly higher crash risk compared to healthy controls. However, there was no evidence of increased crash risk among patients in H&Y stage 1
Another survey study: 82% of patients with PD held a driving license and 60% of them were still driving. Of the patients holding a driving license, 15% reported being involved in an accident.
Drivers with PD may not reveal medical information when renewing their license or adhere to physician's advice to quit driving.
Evidence-Based
Tying it all together! Neurological disorders
are most frequent cause for driving disability
Most studies focus on epilepsy and dementia followed by parkinson’s D
For epilepsy most studies and regulations focus on seizure-free period before allowing to drive again
For dementia ; evidence-based guidelines are available to help the physician to take his decision