Abstracts

People who have seizures, including PNES, are advised to stop driving, or have their driving privileges revoked until seizure-freedom is achieved.  Although there are genuine concerns that support driving prohibitions, losing this privilege can significantly hinder independence, income, and quality of life.  This is especially true in countries like the USA, where a majority depend on driving. In this retrospective study, we compared patients with PNES who requested driving privileges or reported having resumed driving to those who did not on questionnaires of depression, anxiety, and PTSD as well as cognitive flexibility and motor speed.  This project replicates a smaller study that examined psychological functioning of patients with PNES requesting driving resumption; it which concluded that those who applied for driving privileges had significantly lower depression scores.  

A subset of 403 patients diagnosed with PNES (2010-2020) at the Northeast Regional Epilepsy Group were identified.  Exclusion criteria, 1) diagnosis of PNES and epilepsy and 2) younger than age 18 (age of unrestricted driving in most states).  For each patient, requests for reinstatement of driving privileges (requiring 6 months seizure freedom in NJ) and neuropsychological testing scores were checked.

A total of 365 patients were included. Of those, 61 (17%) were pursuing driving privileges and 304 had not.  Mood and anxiety symptoms were assessed with self-report questionnaires.   Fine motor functions and speed were measured with the Grooved Pegboard Test (GPT) and Delis Kaplan Executive Function System (DKEFS).  Comparisons were made using t-tests.  Results demonstrated a statistically significant difference in the Center for Epidemiological Studies-Depression between those who sought driving privileges and those who did not.  A significant difference was also seen in measures of motor performance between both groups on four of the DKEFS Trail Making parts and on the GPT (dominant hand).

Overall, findings demonstrated significantly lower depression symptoms and better performance on tests of motor speed and cognitive flexibility in patients who had re-applied for their driving privileges than the others.   Depression is commonly associated with diminished performance on tests of motor functioning (slower motor response times and impaired fine motor movements). These findings suggest that mood symptoms (and performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES.  This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.