Driving after epilepsy surgery: effects of visual field defects and epilepsy control
Driving after epilepsy surgery: effects of visual field defects and epilepsy control
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癫痫手术后驾驶：视野缺损和癫痫控制的影响
DOI：
10.1080/0268869021000030258
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发表时间：
2002
影响因子：
1.1
通讯作者：
R. Hatfield
中科院分区：
文献类型：
--
作者：
Abhi Ray;V. Pathak;Ronald Walters;R. Hatfield
这项研究的目的是评估接受前颞叶切除术的内侧颞叶硬化症患者的驾驶资格。决定患者手术后驾驶能力的两个主要因素是视野缺陷及其发作频率。入选患者13例。术后癫痫发作频率按Engel‘s标准评定。进行自动静态视野检查，其中包括Humphrey视野分析仪(HFA)30-2测试，每只眼睛一次，以及双目Esterman 120测试。13名入选患者中有7名(54%)术后没有癫痫发作(Engel‘s 1)；3名(23%)患者每年癫痫发作少于2次(Engel’s 2)，3名(23%)癫痫发作频率改善90%以上(Engel‘s 3)。七名术后无癫痫发作的病人均符合申请驾驶执照的资格。对同一患者进行的自动静态视野检查显示，3例(23%)有正常视野或非特异性丢失，7例(54%)有部分同名象限视，1例(8%)有完全同名象限视，2例(15%)有可归因于Vigabatrin的双侧向心性丢失，这可能掩盖了手术造成的任何损失。在13名患者中，只有7名(54%)通过了标准化的DVLA Esterman视野测试。未通过DVLA Esterman视野检查的6例(46%)中，1例有完全同名象限视，3例有不完全同名象限视，2例有向心性丢失(由于Vigabatrin)。虽然7名患者(54%)通过了视野测试，7名患者(54%)没有癫痫发作，但在7名没有癫痫发作的患者中，只有5名患者(即患者总数的38%)的视野符合驾驶资格。由于驾驶现在被患者描述为提高他们生活质量的一个主要因素，强调手术或其他医源性视野缺陷的重要性，这些缺陷可能会阻止他们在手术前驾驶，以避免手术后的失望。
The aim of this study was to assess the eligibility to drive in patients with mesial temporal sclerosis who undergo anterior temporal lobectomy. The two major determinants in a patient's ability to drive after such surgery are visual field defects and their seizure frequency. Thirteen patients were selected. The postoperative seizure frequency was assessed using Engel's criteria. Automated static perimetry was performed which consisted of a Humphrey Field Analyser (HFA) 30-2 Test, one for each eye and a Binocular Esterman 120 Test. Seven out of the 13(54%) selected patients had no seizures post-operatively (Engel's 1); three (23%) patients had less than two seizures per year (Engel's 2) and three (23%) had more than 90% improvement in the frequency of seizures (Engel's 3). The seven patients with no seizures postoperatively were eligible to apply for a driving licence. Automated static perimetry performed on the same patients revealed three (23%) had normal visual field or non-specific loss, seven (54%) had partial homonymous quadrantanopia, one (8%) had complete homonymous quadrantanopia and two (15%) had bilateral concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of the 13 patients, only seven (54%) passed the standardised DVLA Esterman visual field test. Of the six (46%) who failed DVLA Esterman visual field test, one had complete homonymous quadrantanopia, three had incomplete homonymous quadrantanopia and two had concentric loss (due to vigabatrin). Although seven (54%) patients passed the visual field test and seven (54%) patients were seizure free only five of the seven seizure-free patients (i.e. 38% of the total number of patients) had visual fields that would make them eligible to drive. As driving is now stated by patients as a major factor that improves their quality of life, it is important to stress the significance of surgically induced or other iatrogenic visual field defects that may prevent them from driving prior to the operation to avoid disappointments afterwards.