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  • Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRC Antiepileptic Drug Withdrawal Study and a systematic review

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Research paper
Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRC Antiepileptic Drug Withdrawal Study and a systematic review
  1. Laura J Bonnett1,
  2. Arif Shukralla2,
  3. Catrin Tudur-Smith1,
  4. Paula R Williamson1,
  5. Antony G Marson3
  1. 1Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, UK
  2. 2Clinical Sciences Centre, University of Liverpool, UK
  3. 3Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor Antony G Marson, Department of Neurological Science, Clinical Sciences Centre, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK; a.g.marson{at}liverpool.ac.uk

Abstract

Background In the UK, patients with epilepsy in remission, who withdraw antiepileptic drug (AED) treatment, are advised not to drive during withdrawal and for 6 months thereafter, assuming the risk of recurrence in the next 12 months is below 20%. Those with a seizure recurrence currently have to be seizure-free for 12 months before returning to drive, whether treatment is restarted or not. New EU regulations recommend returning to driving 3 months after restarting treatment.

Methods Regression modelling of data from the Medical Research Council AED withdrawal study was undertaken to estimate the risk of seizure recurrence in the next 12 months at various time points following: completion of drug withdrawal; AED reinstatement for those with a recurrence. A systematic review of prospective studies was also undertaken.

Results Immediately following treatment withdrawal, the recurrence risk in the next 12 months was 30% (95% CI 25% to 35%) and at 3 months after withdrawal was 15% (95% CI 10% to 19%). At 3 months following the recommencement of treatment following a seizure recurrence, the risk of a seizure in the next 12 months was 26% (95% CI 17% to 35%), at 6 months 18% (95% CI 10% to 27%) and at 12 months 17% (95% CI 3% to 27%). Systematic review results were similar.

Conclusion Current UK legislation concerning time off driving after withdrawing AED treatment may be too conservative. For those restarting treatment after a recurrence, current UK guidance may be too conservative but the new EU guidance too liberal.

  • Epilepsy
  • adults
  • driving
  • drug withdrawal
  • epilepsy
  • other

http://dx.doi.org/10.1136/jnnp.2010.222885

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    Footnotes

    • Funding This programme (RP-PG-0606-1062) receives financial support from the National Institute for Health Research (NIHR) Programme Grants for Applied Research funding scheme. The original trial was funded by the Medical Research Council.

    • Competing interests All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) LJB, AS, CTS, PRW and AGM do not have support from any company for the submitted work; (2) LJB, AS, CTS, PRW and AGM have no relationship with any company that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) LJB, AS, CTS, PRW and AGM have no non-financial interests that may be relevant to the submitted work. In addition, PRW and AGM sit on the Secretary of State for Transport's Honorary Medical Advisory Panel.

    • Provenance and peer review Not commissioned; externally peer reviewed.