Non-epileptic paroxysmal phenomena and driving
It is important to distinguish epilepsy from other paroxysmal clinical conditions that are also disabling for driving, such as.
Basilar migraine
Following the prodromes of dizziness, scotomas, and ataxia, headache appears with vegetative disorders and severe dulling.
Migraine crisis with aura
Visual or somatosensory prodromes can be confused with focal epileptic crises.
In migraine, paresthesia affects in patches the hand, the mouth, the tongue and sometimes the feet.
Syncope
Vasovagal and orthostatic syncopes are more common in young people.
After a more or less brief prodrome with feeling of lack of appetite, obtundation, tinnitus, heat or cold, and general laxity, the patient becomes unconscious, pale and with cold sweat.
When he awakes, he usually notices tiredness, nausea, vomiting, and shivering.
In adults the most common syncopes are tussigenic in obese smokers, and mictional for vagal reflex when the bladder is emptied while standing and potentiated by the frequent excessive alcohol intake.
In elderly people the syncopes are cardiogenic or by hypersensitivity of the carotid sinus.
In any syncope brain anoxia can occur, that causes seizures, as often in cardiogenic syncopes due to atrioventricular blockade or Stoke-Adams crises.
Seizures in syncopes are usually very short, with tonic extension and a few clonic shakes of the head and the arms in flexure, where the patient can bite the tip of his tongue.
Narcolepsy syndrome
The patient shows a crisis of irresistible somnolence, and crisis of muscle hypotonia where he can fall motionless on the floor, but conscious and without respiratory disorders.
Crisis of psychogenic unconsciousness
Some are associated with inertia and hypotonia of slow onset, the patient stays silent, closes his eyes and does not respond to environmental stimuli.
Other psychogenic crises are often associated with psychomotor restlessness of sudden onset, associated with an emotional setback.
Abnormal paroxysmal movements
They have a light similarity with epileptic crises, as in the carpopedal spasm of tetany, acute dystonia, and paroxysmal familial choreoathetosis.
Drop-attacks
They are crisis with falling on the floor for leg weakness, without loss of consciousness, or associated neurological symptom.
They can be seen in women without serious pathological cause, and also in elderly people for atherosclerosis or low heart output due to vertebrobasilar ischemia.
Transient ischemic attack (TIA)
Located in the carotid territory, it can cause seizures of the contralateral hemibody, but the most frequent are paresis and hypotonia.
These patients often have an emboligenic condition or atherosclerotic disease.
A patient with a previous cerebral ischemic attack can subsequently suffer seizures if the infarcted area becomes a chronic focus of post-infarction epilepsy.
Hypoglycemic crises
They can cause seizures at any age.
Transient global amnesia
Unlike the complex partial crises, it is not associated with symptoms such as hallucinations, dysphasia, confusion, or seizures.>
Ménière disease
The crisis is usually associated with acute sounds, including whistling, hypoacusis of perception of variable intensity, and systematized dizziness of peripheral type.
It can be associated with nausea, vomiting, temporoparietal headache, sensation of heat, sweating, etc.
The order of appearance of the symptoms is variable leading to different clinical forms, but in all cases disabling for driving.
Managed in case they need it.
Advice on non-epileptic paroxysmal phenomena
- Non-epileptic paroxysmal phenomena are disabling for driving
- The symptomatic and causal treatment with a favorable outcome, and always after a more or less prolonged safety period when the patient is free from symptoms, will allow the physician for assessing the possibility that the patient drives again, provided there is no risk of seizures, loss of consciousness or motor disorders.
- If the driver begins to notice symptoms already known of onset of a paroxysmal disorder, he should know that he must stop the car and ask for assistance, following the recommendations given by his physician based on the causal disease.
- These drivers, though controlled, must know that in long journeys they must drive accompanied by people who know their problem, in case an unexpected event occurs.*
- The medical report must be in visible place inside the car, to be adequately managed in case they need it.