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

Kai Michael Schubert; Giulio Bicciato; Lucia Sinka; Laura Abraira; Estevo Santamarina; José Álvarez-Sabín; Carolina Ferreira-Atuesta; Mira Katan; Natalie Scherrer; Robert Terziev; Nico Döhler; Barbara Erdélyi-Canavese; Ansgar Felbecker; Philip Siebel; Michael Winklehner; Tim J von Oertzen; Judith N Wagner; Gian Luigi Gigli; Annacarmen Nilo; Francesco Janes; Giovanni Merlino; Mariarosaria Valente; María Paula Zafra-Sierra; Luis Carlos Mayor-Romero; Julian Conrad; S Evers; Piergiorgio Lochner; Frauke Roell; Francesco Brigo; Carla Bentes; Rita Peralta; Teresa Pinho E Melo; Mark R Keezer; John Sidney Duncan; Josemir W Sander; Barbara Tettenborn; Matthias Koepp; Marian Galovic

doi:10.1136/jnnp-2024-333505

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

Kai Michael Schubert
, Giulio Bicciato
, Lucia Sinka
, Laura Abraira
, Estevo Santamarina
, José Álvarez-Sabín
, Carolina Ferreira-Atuesta
, Mira Katan
, Natalie Scherrer
, Robert Terziev
, Nico Döhler
, Barbara Erdélyi-Canavese
, Ansgar Felbecker
, Philip Siebel
, Michael Winklehner
, Tim J von Oertzen
, Judith N Wagner
, Gian Luigi Gigli
, Annacarmen Nilo
, Francesco Janes

Giovanni Merlino, Mariarosaria Valente, María Paula Zafra-Sierra, Luis Carlos Mayor-Romero, Julian Conrad, S Evers, Piergiorgio Lochner, Frauke Roell, Francesco Brigo, Carla Bentes, Rita Peralta, Teresa Pinho E Melo, Mark R Keezer, John Sidney Duncan, Josemir W Sander, Barbara Tettenborn, Matthias Koepp, Marian Galovic

Department of Neurology

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	833-837
Number of pages	5
Journal	Journal of Neurology, Neurosurgery and Psychiatry
Volume	95
Issue number	9
DOIs	https://doi.org/10.1136/jnnp-2024-333505
Publication status	Published - 16 Aug 2024

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This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Fields of science

302052 Neurology

Access to Document

10.1136/jnnp-2024-333505

Cite this

Schubert, K. M., 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, T. J., Wagner, J. N., Gigli, G. L., Nilo, A., ... Galovic, M. (2024). Implications for driving based on the risk of seizures after ischaemic stroke. Journal of Neurology, Neurosurgery and Psychiatry, 95(9), 833-837. https://doi.org/10.1136/jnnp-2024-333505

@article{b217b21b623e48ecb315eeec61ac1b42,

title = "Implications for driving based on the risk of seizures after ischaemic stroke",

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 = "Humans, Automobile Driving, Seizures/etiology, Ischemic Stroke/complications, Male, Female, Aged, Middle Aged, Risk Factors, Aged, 80 and over, Prognosis, Cohort Studies, Adult",

author = "Schubert, \{Kai Michael\} and Giulio Bicciato and Lucia Sinka and Laura Abraira and Estevo Santamarina and Jos{\'e} {\'A}lvarez-Sab{\'i}n and Carolina Ferreira-Atuesta and Mira Katan and Natalie Scherrer and Robert Terziev and Nico D{\"o}hler and Barbara Erd{\'e}lyi-Canavese and Ansgar Felbecker and Philip Siebel and Michael Winklehner and \{von Oertzen\}, \{Tim J\} and Wagner, \{Judith N\} and Gigli, \{Gian Luigi\} and Annacarmen Nilo and Francesco Janes and Giovanni Merlino and Mariarosaria Valente and Zafra-Sierra, \{Mar{\'i}a Paula\} and Mayor-Romero, \{Luis Carlos\} and Julian Conrad and S Evers and Piergiorgio Lochner and Frauke Roell and Francesco Brigo and Carla Bentes and Rita Peralta and \{Pinho E Melo\}, Teresa and Keezer, \{Mark R\} and Duncan, \{John Sidney\} and Sander, \{Josemir W\} and Barbara Tettenborn and Matthias Koepp and Marian Galovic",

note = "{\textcopyright} 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.",

year = "2024",

month = aug,

day = "16",

doi = "10.1136/jnnp-2024-333505",

language = "English",

volume = "95",

pages = "833--837",

journal = "Journal of Neurology, Neurosurgery and Psychiatry",

issn = "1468-330X",

number = "9",

}

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 & Galovic, M 2024, 'Implications for driving based on the risk of seizures after ischaemic stroke', Journal of Neurology, Neurosurgery and Psychiatry, vol. 95, no. 9, pp. 833-837. https://doi.org/10.1136/jnnp-2024-333505

TY - JOUR

T1 - Implications for driving based on the risk of seizures after ischaemic stroke

AU - Schubert, Kai Michael

AU - Bicciato, Giulio

AU - Sinka, Lucia

AU - Abraira, Laura

AU - Santamarina, Estevo

AU - Álvarez-Sabín, José

AU - Ferreira-Atuesta, Carolina

AU - Katan, Mira

AU - Scherrer, Natalie

AU - Terziev, Robert

AU - Döhler, Nico

AU - Erdélyi-Canavese, Barbara

AU - Felbecker, Ansgar

AU - Siebel, Philip

AU - Winklehner, Michael

AU - von Oertzen, Tim J

AU - Wagner, Judith N

AU - Gigli, Gian Luigi

AU - Nilo, Annacarmen

AU - Janes, Francesco

AU - Merlino, Giovanni

AU - Valente, Mariarosaria

AU - Zafra-Sierra, María Paula

AU - Mayor-Romero, Luis Carlos

AU - Conrad, Julian

AU - Evers, S

AU - Lochner, Piergiorgio

AU - Roell, Frauke

AU - Brigo, Francesco

AU - Bentes, Carla

AU - Peralta, Rita

AU - Pinho E Melo, Teresa

AU - Keezer, Mark R

AU - Duncan, John Sidney

AU - Sander, Josemir W

AU - Tettenborn, Barbara

AU - Koepp, Matthias

AU - Galovic, Marian

PY - 2024/8/16

Y1 - 2024/8/16

N2 - 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.

AB - 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.

KW - Humans

KW - Automobile Driving

KW - Seizures/etiology

KW - Ischemic Stroke/complications

KW - Male

KW - Female

KW - Aged

KW - Middle Aged

KW - Risk Factors

KW - Aged, 80 and over

KW - Prognosis

KW - Cohort Studies

KW - Adult

UR - https://www.scopus.com/pages/publications/85193946450

U2 - 10.1136/jnnp-2024-333505

DO - 10.1136/jnnp-2024-333505

M3 - Article

C2 - 38749674

SN - 1468-330X

VL - 95

SP - 833

EP - 837

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

IS - 9

ER -

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

Abstract

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