Eli Cohen1,2, Prince Antwi1, Barbara C Banz3,4, Peter Vincent1, Rick Saha1, Christopher A Arencibia1, Jun H Ryu1, Ece Atac1,5, Nehan Saleem1, Shiori Tomatsu1, Kohleman Swift1, Claire Hu1, Heinz Krestel1,6, Pue Farooque1, Susan Levy1, Jia Wu4,7, Michael Crowley4,7, Federico E Vaca3,4,7, Hal Blumenfeld1,8,9. 1. Department of Neurology, Yale School of Medicine, New Haven, Connecticut. 2. Central Caribbean University School of Medicine, Bayamón, Puerto Rico. 3. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. 4. Child Study Center, Yale School of Medicine, New Haven, Connecticut. 5. Faculty of Medicine, Hacettepe University, Ankara, Turkey. 6. Epilepsy Center Frankfurt Rhein-Main, Center for Personalized Translational Epilepsy Research, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. 7. Developmental Neurocognitive Driving Simulation Research Center, Yale School of Medicine, New Haven, Connecticut. 8. Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut. 9. Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.
Abstract
OBJECTIVE: Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. METHODS: Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs. RESULTS: Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 μV vs 52.99 μV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). SIGNIFICANCE: High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk. Wiley Periodicals, Inc.
OBJECTIVE: Generalized epileptiform discharges (GEDs) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GEDs is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GEDs, and to begin evaluating electroencephalographic (EEG) features in relation to driving safety. METHODS: Subjects were aged ≥15 years with generalized epilepsy, GEDs on EEG, and no clinical seizures. Using a high-fidelity driving simulator (miniSim) with simultaneous EEG, a red oval visual stimulus was presented every 5 minutes for baseline testing, and with each GED. Participants were instructed to pull over as quickly and safely as possible with each stimulus. We analyzed driving and EEG signals during GEDs. RESULTS: Nine subjects were tested, and five experienced 88 GEDs total with mean duration 2.31 ± 1.89 (SD) seconds. Of these five subjects, three responded appropriately to all stimuli, one failed to respond to 75% of stimuli, and one stopped driving immediately during GEDs. GEDs with no response to stimuli were significantly longer than those with appropriate responses (8.47 ± 3.10 vs 1.85 ± 0.69 seconds, P < .001). Reaction times to stimuli during GEDs were significantly correlated with GED duration (r = 0.30, P = .04). In addition, EEG amplitude was greater for GEDs with no response to stimuli than GEDs with responses, both for overall root mean square voltage amplitude (66.14 μV vs 52.99 μV, P = .02) and for fractional power changes in the frequency range of waves (P < .05) and spikes (P < .001). SIGNIFICANCE: High-fidelity driving simulation is feasible for investigating driving behavior during GEDs. GEDs with longer duration and greater EEG amplitude showed more driving impairment. Future work with a large sample size may ultimately enable classification of GED EEG features to predict individual driving risk. Wiley Periodicals, Inc.
Authors: Avisha Kumar; Reese Martin; William Chen; Andrew Bauerschmidt; Mark W Youngblood; Courtney Cunningham; Yang Si; Cel Ezeani; Zachary Kratochvil; Jared Bronen; James Thomson; Katherine Riordan; Ji Yeoun Yoo; Romina Shirka; Louis Manganas; Heinz Krestel; Lawrence J Hirsch; Hal Blumenfeld Journal: Epilepsia Date: 2021-11-24 Impact factor: 5.864
Authors: Simon Henin; Anita Shankar; Helen Borges; Adeen Flinker; Werner Doyle; Daniel Friedman; Orrin Devinsky; György Buzsáki; Anli Liu Journal: Brain Date: 2021-06-22 Impact factor: 15.255
Authors: Charlie W Zhao; Rahiwa Gebre; Yigit Baykara; William Chen; Petr Vitkovskiy; Ningcheng Li; Michelle Johnson; Eric Y Chen; Dan Kluger; Hal Blumenfeld Journal: Ann Clin Transl Neurol Date: 2022-01-11 Impact factor: 4.511
Authors: Max Springer; Aya Khalaf; Peter Vincent; Jun Hwan Ryu; Yasmina Abukhadra; Sandor Beniczky; Tracy Glauser; Heinz Krestel; Hal Blumenfeld Journal: Ann Clin Transl Neurol Date: 2022-09-16 Impact factor: 5.430