Abstracts

Rationale: Due to their semiological similarities, psychogenic nonepileptic seizures (PNES) represent an important and frequent differential diagnosis to epileptic seizures. In contrast to patients with epilepsy, data about driving accidents in patients with PNES are scarce and do not allow sufficient conclusion on driving risks. Therefore we tried to seek expert opinion on recommendations for driving of PNES patients from German Epileptologists. Methods: Similar to a study of Benbadis et al in the USA (Epilepsia 41, 2000, 895-7), 41 experienced German epileptologists were contacted by e-mail and were asked to answer the following question: “what is your recommendation for a patient with PNES (without additional epilepsy) concerning his/her driving ability?” The choices were (1) apply the same restrictions as in official regulations for patients with epilepsy; (2) apply no restrictions; and (3) follow an individualized approach. The results were compared with those found by Benbadis et al. Results: Thirty-four of epileptologists (83%) responded. Eleven (32%) applied the same restrictions as stipulated for patients with epileptic seizures, 23 (68%) decided on an individual basis while no physician perceived PNES patients fit for driving without any restrictions. The respective figures in the study by Benbadis et al were 49%, 19% and 32%. Conclusions: Two-thirds of epilepsy experts in Germany suggest an individual assessment of driving ability in patients with PNES. This seems to reflect the great variability of PNES concerning semiology, frequency, risks of injuries, etiology and prognosis of the attacks. In contrast to one third of epilepsy experts in the USA, no German neurologist perceived PNES patients being fit for driving in general. One explanation might be that in the German driving regulations persons with PNES are dealt with in the section “seizure disorders” where driving ability as a rule is denied as long as a “substantial” recurrence risk exists. Conditions under which driving is permitted are however defined only for persons with epilepsy. Additional Studies about driving risks in patients with PNES are needed.