Abstracts

Rationale: In many parts of the United States, reinstatement of driving privileges is essentially required for a full return to work, school and other life activities. The ability to resume driving safely following epilepsy surgery may also be a surrogate indicator of surgical outcome. The State of Utah requires patients to maintain seizure freedom for three months in order to drive. Because Utah is a predominantly rural state where driving incapacity can cause significant negative impact, we sought to determine return to driving rates following epilepsy surgery. Based on cited statistics we would anticipate that frontal lobe resections would have lower return to driving rates when compared to temporal lobe resections. Methods: We performed a retrospective chart review of all adult patients who underwent epilepsy surgery between October 2005 and January 2009 by a single surgeon. Patient outcomes were analyzed for greater than or equal to three months of freedom from seizures that impair awareness, which is the Utah State Department of Motor Vehicles criterion for resumption of driving. Outcomes were grouped based on type and lobar location of the surgery performed. Results: Epilepsy surgery was performed on 62 patients, 7 of whom had had limited follow-up data and were therefore excluded from further analysis. Sixty percent (33/55) of analyzed patients met the criterion to legally resume driving. Of those legally able to resume driving, 5/33 patients were able to fully discontinue anti-epileptic drugs (AEDs) and an additional 4 patients were actively tapering off AEDs. Seizure recurrence occurred in 18/33 (55%) patients during planned medication reductions. However, these patients ultimately met the legal standard for driving with the resumption of AEDs. Conclusions: As the resumption of driving is critical for most patients in the State of Utah to be able to maintain employment or attend school, it is encouraging that a majority of patients surgically treated for epilepsy were legally able to do so. The likelihood that a patient would be able to resume driving after epilepsy surgery did not differ significantly between frontal lobe and temporal lobe resections. Also notably, 55% of patients had seizure recurrence when a medication taper was attempted and thus needed to maintain at least 1 AED in order to maintain seizure freedom and retain driving privileges. While the majority of patients were able to legally resume driving following epilepsy surgery, most patients required continued AED therapy to do so.