Purpose: Proper judgement of the aptitude of people with epilepsy (PWE) for driving is a critical issue, both medically and socially. One thus far reported approach is a quantitative comparison of the risk of fatal traffic accidents caused by PWE drivers and that by subgroups of drivers in the general population. We propose a new approach that compares the risk posed by PWE drivers and that by sudden death of occupational drivers, and the maximum driving time for PWE based on that comparison.
Method: The risk of fatal traffic accidents was estimated using four variables. The value assigned to each variable was determined using reports and statistics.
Results: The risk of fatal traffic accidents caused by sudden death of occupational drivers was estimated to be 7.6×10-5/year, 4.9×10-5/year, and 1.7×10-5/year for large-sized, mid-sized and normal-sized vehicles. The risk of fatal traffic accidents caused by PWE drivers was estimated to be 5.3×10-5/year and 3.2×10-5/year for PWE with seizure-free periods of 1 year and 2 years, respectively. The maximum acceptable driving time for PWE having a 2-year seizure-free period at the equivalent risk caused by sudden death of occupational drivers of mid-sized vehicles was estimated to be 304 min/week.
Conclusion: The risk of fatal traffic accidents caused by PWE drivers can be evaluated by comparing to that caused by sudden death of occupational drivers. Such risk posed by PWE drivers having a 2-year seizure-free period was less than that caused by sudden death of occupational drivers of mid-sized vehicles. Assuming that the society accepts the latter risk, PWE may be permitted to drive for an estimated maximum time at the equivalent risk of causing a fatal accident.
Purpose: To investigate the adverse effects of adrenocorticotropic hormone (ACTH) therapy on function of the hypothalamic-pituitary-adrenal (HPA) axis and the necessity of subsequent adrenocortical hormone replacement therapy (HRT).
Methods: We conducted a retrospective review of patients with epilepsy who received ACTH therapy and underwent assessment of HPA axis function.
Results: Six cases analyzed for hormones, including a symptomatic patient with HPA axis insufficiency (HPAI), were studied. Serum cortisol concentrations in the morning were at HPAI levels (<5.0 µg/dL) in three cases, at suspected HPAI levels (>5.0 and <13 µg/dL) in two cases, and normal in one case. However, in the corticotrophin-releasing hormone (CRH) test, while both serum cortisol and plasma ACTH levels were reactive in five cases, only one case exhibited lazy patterns in the time courses of serum cortisol and plasma ACTH levels. Consequently, all six patients who received ACTH therapy had some degree of HPA axis hypofunction for approximately 2-3 months after ACTH therapy and were treated with HRT.
Conclusion: Patients who receive ACTH therapy may be at r isk of HPA axis hypofunction for a certain period and HRT may be recommended until their serum cortisol levels return to basal levels.