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癫痫发作和癫痫患者的驾驶限制

Authors
Allan Krumholz, MD
Jennifer Hopp, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
孙伟, 主任医师，教授

引言

尽管关于癫痫与驾驶仍有很多不确定且具有争议，通常下面几个方面已有共识：

●有未控制的癫痫的患者驾驶机动车，有机动车辆事故(motor vehicle accident, MVA)的风险，机动车辆事故会导致财产损失和自身及他人受伤甚至死亡。

●对于许多成人，限制驾驶会严重限制他们去上学、工作和参加社会活动的能力，因而严重降低他们的独立性和生存质量。

这些观点体现了癫痫患者驾驶限制这一问题会造成公共健康及安全与癫痫患者机遇增加及最佳生存质量之间的冲突。当癫痫患者被问及癫痫对他们生存质量的影响时，驾驶被列为最关注的问题[1,2]。目前的法规和指南试图平衡这些潜在冲突的目标。

对癫痫患者的驾驶限制可追溯到驾驶证的初次发放，那时癫痫患者必然被禁止驾驶[3]。随着有效的抗癫痫药(antiepileptic drugs, AED)的发展，以及发现许多癫痫患者可被很好地控制因而驾驶时癫痫发作的风险低，法律已经相继修订，放松了这种完全限制。

               

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Literature review current through: 2017-06 . | This topic last updated: 2016-09-28.
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References
Top
  1. Gilliam F, Kuzniecky R, Faught E, et al. Patient-validated content of epilepsy-specific quality-of-life measurement. Epilepsia 1997; 38:233.
  2. Moran NF, Poole K, Bell G, et al. Epilepsy in the United Kingdom: seizure frequency and severity, anti-epileptic drug utilization and impact on life in 1652 people with epilepsy. Seizure 2004; 13:425.
  3. Krumholz A, Fisher RS, Lesser RP, Hauser WA. Driving and epilepsy. A review and reappraisal. JAMA 1991; 265:622.
  4. National center for statistics and analysis of the National highway traffic safety administration. Traffic safety facts annual report 2004 final edition. Available at http://www-nrd.nhtsa.dot.gov/departments/nrd-30/ncsa/ (Accessed on February 9, 2006).
  5. Drazkowski JF, Fisher RS, Sirven JI, et al. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clin Proc 2003; 78:819.
  6. van der Lugt PJ. Traffic accidents caused by epilepsy. Epilepsia 1975; 16:747.
  7. Taylor J, Chadwick D, Johnson T. Risk of accidents in drivers with epilepsy. J Neurol Neurosurg Psychiatry 1996; 60:621.
  8. Waller JA. Chronic medical conditions and traffic safety: review of the California experience. N Engl J Med 1965; 273:1413.
  9. Crancer A Jr, O'Neall PA. A record analysis of Washington drivers with license restrictions for heart disease. Northwest Med 1970; 69:409.
  10. Hansotia P, Broste SK. The effect of epilepsy or diabetes mellitus on the risk of automobile accidents. N Engl J Med 1991; 324:22.
  11. Masland RL. The physician's responsibility for epileptic drivers. Ann Neurol 1978; 4:485.
  12. Kwon C, Liu M, Quan H, et al. Motor vehicle accidents, suicides, and assaults in epilepsy: a population-based study. Neurology 2011; 76:801.
  13. Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy. Neurology 2004; 63:1002.
  14. Barrow, RL, Fabing, HD. Driver's licensing laws. In: Epilepsy and the Law, Hoeber Medical Division of Harper and Row, New York 1966. p.57.
  15. Lee W, Wolfe T, Shreeve S. Reporting epileptic drivers to licensing authorities is unnecessary and counterproductive. Ann Emerg Med 2002; 39:656.
  16. Krauss GL, Ampaw L, Krumholz A. Individual state driving restrictions for people with epilepsy in the US. Neurology 2001; 57:1780.
  17. Krauss GL, Krumholz A, Carter RC, et al. Risk factors for seizure-related motor vehicle crashes in patients with epilepsy. Neurology 1999; 52:1324.
  18. van der Lugt PJ. Is an application form useful to select patients with epilepsy who may drive? Epilepsia 1975; 16:743.
  19. Taylor J, Chadwick DW, Johnson T. Accident experience and notification rates in people with recent seizures, epilepsy or undiagnosed episodes of loss of consciousness. QJM 1995; 88:733.
  20. Lings S. Increased driving accident frequency in Danish patients with epilepsy. Neurology 2001; 57:435.
  21. Berg AT, Vickrey BG, Sperling MR, et al. Driving in adults with refractory localization-related epilepsy. Multi-Center Study of Epilepsy Surgery. Neurology 2000; 54:625.
  22. Gastaut H, Zifkin BG. The risk of automobile accidents with seizures occurring while driving: relation to seizure type. Neurology 1987; 37:1613.
  23. Consensus statements, sample statutory provisions, and model regulations regarding driver licensing and epilepsy. American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America. Epilepsia 1994; 35:696.
  24. Beghi E, Sander JW. Epilepsy and driving. BMJ 2005; 331:60.
  25. Rémillard GM, Zifkin BG, Andermann F. Epilepsy and motor vehicle driving--a symposium held in Québec City, November 1998. Can J Neurol Sci 2002; 29:315.
  26. Blume WT. Diagnosis and management of epilepsy. CMAJ 2003; 168:441.
  27. Bacon D, Fisher RS, Morris JC, et al. American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence. Neurology 2007; 68:1174.
  28. van den Broek M, Beghi E, RESt-1 Group. Accidents in patients with epilepsy: types, circumstances, and complications: a European cohort study. Epilepsia 2004; 45:667.
  29. Kasteleijn-Nolst Trenité DG, Vermeiren R. The impact of subclinical epileptiform discharges on complex tasks and cognition: relevance for aircrew and air traffic controllers. Epilepsy Behav 2005; 6:31.
  30. Bonnett LJ, Shukralla A, Tudur-Smith C, et al. Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRC Antiepileptic Drug Withdrawal Study and a systematic review. J Neurol Neurosurg Psychiatry 2011; 82:1328.
  31. Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients? CNS Drugs 2004; 18:201.
  32. Lhatoo SD, Sander JW. Stopping drug therapy in epilepsy. Curr Pharm Des 2000; 6:861.
  33. Bonnett LJ, Tudur-Smith C, Williamson PR, Marson AG. Risk of recurrence after a first seizure and implications for driving: further analysis of the Multicentre study of early Epilepsy and Single Seizures. BMJ 2010; 341:c6477.
  34. Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69:1996.
  35. Thomas RH, King WH, Johnston JA, Smith PE. Awake seizures after pure sleep-related epilepsy: a systematic review and implications for driving law. J Neurol Neurosurg Psychiatry 2010; 81:130.
  36. Fisher RS, Parsonage M, Beaussart M, et al. Epilepsy and driving: an international perspective. Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy. Epilepsia 1994; 35:675.
  37. http://www.ibe-epilepsy.org/activities/epilepsy-and-driving. (Accessed on April 7, 2010).
  38. Shareef YS, McKinnon JH, Gauthier SM, et al. Counseling for driving restrictions in epilepsy and other causes of temporary impairment of consciousness: how are we doing? Epilepsy Behav 2009; 14:550.
  39. Finucane AK. Legal aspects of epilepsy. Neurol Clin 1999; 17:235.
  40. Salinsky MC, Wegener K, Sinnema F. Epilepsy, driving laws, and patient disclosure to physicians. Epilepsia 1992; 33:469.
  41. McLachlan RS, Jones MW. Epilepsy and driving: a survey of Canadian neurologists. Can J Neurol Sci 1997; 24:345.
  42. McLachlan RS, Starreveld E, Lee MA. Impact of mandatory physician reporting on accident risk in epilepsy. Epilepsia 2007; 48:1500.
  43. Dalrymple J, Appleby J. Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ 2000; 320:94.
  44. Black AB, Lai NY. Epilepsy and driving in South Australia--an assessment of compulsory notification. Med Law 1997; 16:253.
  45. Elliott JO, Long L. Perceived risk, resources, and perceptions concerning driving and epilepsy: a patient perspective. Epilepsy Behav 2008; 13:381.
  46. Long L, Reeves AL, Moore JL, et al. An assessment of epilepsy patients' knowledge of their disorder. Epilepsia 2000; 41:727.
  47. Edmondstone WM. How do we manage the first seizure in adults? J R Coll Physicians Lond 1995; 29:289.
  48. Polychronopoulos P, Argyriou AA, Huliara V, et al. Factors associated with poor compliance of patients with epilepsy driving restrictions. Neurology 2006; 67:869.
  49. Ooi WW, Gutrecht JA. International regulations for automobile driving and epilepsy. J Travel Med 2000; 7:1.