Clinical correlates of post-diagnosis motor vehicle crashes in drivers with Epilepsy: A cross-sectional analysis.

BACKGROUND: Motor vehicle crashes (MVCs) pose a significant hazard to patients with epilepsy; however, the specific clinical and behavioral predictors remain debated. This study examined clinical and behavioral factors associated with epilepsy-related MVCs occurring after diagnosis, focusing on disease severity, seizure semiology, and subjective awareness of warning symptoms while driving. METHODS: This cross-sectional study included 250 driving patients with epilepsy. Clinical and behavioral characteristics were collected by structured questionnaire. Factors associated with post-diagnosis crash were examined using Firth penalized-likelihood logistic regression with multiple imputation, adjusted for age, sex, and disease duration. From the independently associated factors, we derived the Seizure-related Assessment of Factors associated with Events in Driving (SAFE-D) score, an exploratory summary. RESULTS: Of 250 participants, 34 (13.6 %) reported a history of epilepsy-related MVCs. In the multivariable analysis, pharmacoresistant epilepsy (adjusted odds ratio [aOR] 3.23), impending seizure awareness (aOR 3.70), focal impaired consciousness seizures (FICS) relative to bilateral tonic-clonic seizures (aOR 2.78), and longer disease duration (aOR 1.54 per 10 years) were independently associated with post-diagnosis epilepsy-related crash. The SAFE-D score showed an apparent area under the curve (AUC) of 0.747, with an optimism-corrected AUC of 0.730 for the integer score on bootstrap internal validation. CONCLUSIONS: Pharmacoresistance, FICS and subjective awareness of warning symptoms while driving were associated with higher odds of post-diagnosis crash. Counseling about driving may benefit from considering disease severity and seizure semiology alongside seizure-free intervals. The SAFE-D score summarizes these correlates but requires prospective validation before it can inform driving policy.