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Realistic driving simulation during generalized epileptiform discharges to identify electroencephalographic features related to motor vehicle safety: Feasibility and pilot study
Author(s) -
Cohen Eli,
Antwi Prince,
Banz Barbara C.,
Vincent Peter,
Saha Rick,
Arencibia Christopher A.,
Ryu Jun H.,
Atac Ece,
Saleem Nehan,
Tomatsu Shiori,
Swift Kohleman,
Hu Claire,
Krestel Heinz,
Farooque Pue,
Levy Susan,
Wu Jia,
Crowley Michael,
Vaca Federico E.,
Blumenfeld Hal
Publication year - 2020
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16356
Subject(s) - electroencephalography , audiology , psychology , stimulus (psychology) , driving simulator , epilepsy , physical medicine and rehabilitation , medicine , simulation , neuroscience , computer science , cognitive psychology
Objective Generalized epileptiform discharges ( GED s) can occur during seizures or without obvious clinical accompaniment. Motor vehicle driving risk during apparently subclinical GED s is uncertain. Our goals were to develop a feasible, realistic test to evaluate driving safety during GED s, and to begin evaluating electroencephalographic ( EEG ) features in relation to driving safety. Methods Subjects were aged ≥15 years with generalized epilepsy, GED s 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 GED s. Results Nine subjects were tested, and five experienced 88 GED s 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 GED s. GED s 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 GED s were significantly correlated with GED duration ( r = 0.30, P = .04). In addition, EEG amplitude was greater for GED s with no response to stimuli than GED s 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 GED s. GED s 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.