Driving and diseases with potential loss of consciousness

1. DRIVING AND DISEASES
WITH POTENTIAL LOSS OF
CONSCIOUSNESS
Epilepsy and driving

2. WHY IS THIS IMPORTANT?
• No warning signs
• Dangerous for both the driver and the other participant in the traffic
• Possible severe injuries or death

3. DISEASES
• Epilepsy
• Narcolepsy
• Diabetes
• Low blood pressure
• Other cardiac diseases

4. EPILEPSY
• Epilepsy has many types
• Some types cause motor and visual impairment
• Loss of consciousness is also common

5. TYPES
Focal and general
- Epilepsy is at a specific area of
the brain
- Most of the time evolves from
focal epilepsy and becomes
general

6. TYPES – FOCAL –> SIMPLE PARTIAL
SEIZURE
• This is the aura itself
• Might evolve into general seizure (grand mal)
• Various strange symptoms like eg.:
• General strange feeling
• Unusual smells or tastes
• Altered mental status
• Etc.
• Also called: focal onset aware seizure

7. AURA
• Aura is a warning sign before a seizure
• Patient may feel dizzy, sense strange scents or taste
• Aura can help decreasing the injuries from a seizure
• Patient can be put into a safe position

8. TYPES – FOCAL --> COMPLEX
PARTIAL SEIZURE
• Similar to simple partial but:
• Includes change in level of awareness
• This is more relevant in driving
• Also called: focal onset impaired awareness seizure

9. MEDICATION
• Can be one (monotherapy) or multiple different medications
• 70% can be well controlled
• Medications might have side effects
• More and more advanced medications over time
• Less side effects
• Common medications in Hungary: Lamolep (lamotrigin), levetiracetam,
brivaracetam (most advanced)

10. CAUSES
• Infection
• Infections at young age
• High fever, febrile convulsions
• Causes permanent epilepsy in 5% of cases

11. CAUSES
• Neurodevelopmental disorders
• Brain might develop abnormally
• Structural differenc causes altered function
• Seizures
• Genetic factors
• There are known genes tend to cause epilepsy
• There is few detailed evidence
• Usually occur after childhood

12. CAUSES
• Prenatal damage
• Low oxigen during pregnancy
• Or during birth
• Often with other nervous system and mental symptoms

13. CAUSES
• Trauma, Stroke
• Accidents
• Brain cells may necrotise
• Changes nerve transmission
• The balance changes

14. CAUSES
• Tumors
• Similarly to traumas, impacts balance in brain
• The tumor pushes a brain area
• It alters the function of that area
• Causes seizures

15. EPILEPSY AND DRIVING
• Driving is an activity that needs constant attention
• There are many distracting factors also for people with no epilepsy
• If a seizure occurs during driving, it can cause life-threat

16. EPILEPSY AND DRIVING – WHAT HAPPENS?
• In Hungary, someone is considered epileptic if they have at least 2 seizures in
their life
• Even if they are very far from each other in time
• When someone is diagnosed with epilepsy, the doctor will ban them from
driving by default

17. DRIVING AGAIN
• Rules are very strict for getting driving license back
• 1 year with medication with no seizure
• If someone has professional driving license, its 2-3 years.

18. DRIVING AGAIN
• In some cases, driving can be allowed earlier
• This decision is made by a professional team
• There is no capacity for evaluating everyone this way

19. STATISTICS AND IMPACT
• Accident rate 1.13 to 2.16 times higher
• But lower than other high risk groups
• Young drivers, alcohol abuse, old drivers
• Driving is critical: employement, socialization
• Getting banned be very disadvantageous for who „drives for a living”
• (Taxi drivers, truck drivers etc.)

20. OUTLOOK
• In the US one must be seizureless for about year to get (back) license
• In Germany heavy cases → 2 years seizureless
• France → 2 years, but can be reduced
• Australia → 3 to 24 months
• In many countries permanent ban (China, India)

21. TYPES AND EVALUATION
• Focal aware epilepsy
• Less dangerous in traffic → aura
• Detailed evaluation
• Driving might be allowed
• Instructions to the patient

22. TYPES AND EVALUATION
• Focal impaired awareness type
• Includes unconscious periods
• Driving cannot be allowed
• More dangerous than aware tyoe
• Slightly less dangerous than general in traffic

23. TYPES AND EVALUATION
• Generalized epilepsy
• Always causes motor seizures
• Dangerous in traffic
• Driving can’t be allowed
• Only after 1-2 years medication

24. WHAT SHOULD CHANGE
• There should be capacity for evaluating more people individually
• Support for people loseing their job because of getting banned from driving
• Modern systems for predicting seizures even during driving (Neural
networks?)
• Autonomous driving won’t be a solution for a long time
• No fully autonomous driving…

25. POSSIBBLE METHODS OF
„ONBOARD” DETECTION
• Existing driver exhaustion detection systems
• Similar symptoms
• Existing sensors can be used
• New algorhytms for existing hardwares
• New, zero-invasive hardwares?
• Sensor data analyzed by deep neural networks
• Exact algorhytms after detalied conclusion is made

26. SUMMARY
• Many diseases might be dangerous for traffic
• Epilepsy is one complicated case
• Many types
• Focal
• General
• Types differ by danger

27. SUMMARY
• Usually banning from driving
• Some types managed different
• Personal evaluation
• Bottleneck in capacity
• Job loss, social consequences (of no driving) → support
• Detecting seizures → might be more development
• Fully autonomous driving in the far future

28. REFERENCES
• https://www.epilepsy.com/article/2015/8/epilepsy-and-driving
• https://www.epilepsy.com/learn/epilepsy-due-specific-causes
• https://www.neurologiaikozpont.hu/epilepszia-kezelese
• https://www.hazipatika.com/napi_egeszseg/neurologia/cikkek/az_epilepszi
a_okai/20160915110906
• https://www.epilepsy.com/learn/types-seizures/focal-onset-impaired-
awareness-seizures-aka-complex-partial-seizures
• http://www.epilepszia.hu/cikkek/az-epilepsziarol/okok/218/mi-okozza-az-
epilepsziat
• https://www.nhs.uk/conditions/epilepsy/symptoms/
• https://en.wikipedia.org/wiki/Narcolepsy

29. THANK YOU FOR YOUR ATTENTION