Driving status of patients with generalized spike-wave on EEG but no clinical seizures

Antwi, P.; Atac, E.; Ryu, J. H.; Arencibia, C. A.; Tomatsu, S.; Saleem, N.; Wu, J.; Crowley, M. J.; Banz, B.; Vaca, F. E.; Krestel, Heinz; Blumenfeld, H. (2019). Driving status of patients with generalized spike-wave on EEG but no clinical seizures. Epilepsy & behavior, 92, pp. 5-13. Elsevier 10.1016/j.yebeh.2018.11.031

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Generalized spike-wave discharges (SWDs) are the hallmark of generalized epilepsy on the electroencephalogram (EEG). In clinically obvious cases, generalized SWDs produce myoclonic, atonic/tonic, or absence seizures with brief episodes of staring and behavioral unresponsiveness. However, some generalized SWDs have no obvious behavioral effects. A serious challenge arises when patients with no clinical seizures request driving privileges and licensure, yet their EEG shows generalized SWD. Specialized behavioral testing has demonstrated prolonged reaction times or missed responses during SWD, which may present a driving hazard even when patients or family members do not notice any deficits. On the other hand, some SWDs are truly asymptomatic in which case driving privileges should not be restricted. Clinicians often decide on driving privileges based on SWD duration or other EEG features. However, there are currently no empirically-validated guidelines for distinguishing generalized SWDs that are "safe" versus "unsafe" for driving. Here, we review the clinical presentation of generalized SWD and recent work investigating mechanisms of behavioral impairment during SWD with implications for driving safety. As a future approach, computational analysis of large sets of EEG data during simulated driving utilizing machine learning could lead to powerful methods to classify generalized SWD as safe vs. unsafe. This may ultimately provide more objective EEG criteria to guide decisions on driving safety in people with epilepsy.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Krestel, Heinz Eric


600 Technology > 610 Medicine & health








Panagiota Milona

Date Deposited:

28 Mar 2019 07:40

Last Modified:

05 Dec 2022 15:24

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Absence seizures Consciousness Driving safety Driving simulation Epilepsy Subclinical epileptiform discharges





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