Driving regulations and psychogenic non-epileptic seizures: perspectives from the United Kingdom.

The Driver and Vehicle Licensing Agency (DVLA) in the United Kingdom provides guidance on fitness to drive for patients with a number of medical illnesses, including epilepsy and psychogenic non-epileptic seizures (PNES). The Association of British Neurologists circulates a monthly electronic newsletter to its membership by email. We used this newsletter to survey its recipients on the driving advice they offer patients with PNES, and their awareness of current DVLA guidelines. 54 replies were received (19/54 were epilepsy specialists). 11/54 respondents were unaware of any DVLA guidance regarding PNES. Of 43/54 aware of DVLA guidance, only 7% felt that it was sufficient. 40% of respondents did not recommend any driving restriction. 68% of epilepsy specialists recommended driving restriction as compared to 54% of non-epilepsy specialists. 2 respondents reported patients with PNES who had an accident as a consequence of a non-epileptic attack. The risk of motor vehicle accidents in patients with PNES needs further study. Until the establishment of evidence-based guidelines, there is a need to seek consensus and provide sufficient guidance regarding driving for both patients with PNES and their clinicians.

Single gene disorders causing ischaemic stroke.

Stroke is the third most common cause of death and the leading cause of long-term neurological disability in the world. Conventional vascular risk factors for stroke contribute approximately to only forty to fifty percent of stroke risk. Genetic factors may therefore contribute to a significant proportion of stroke and may be polygenic, monogenic or multi-factorial. Monogenic (single gene) disorders may potentially account for approximately one percent of all ischaemic stroke. Monogenic stroke disorders include conditions such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) and hereditary endotheliopathy, retinopathy, nephropathy and stroke (HERNS). In addition, other monogenic conditions such as sickle cell and Fabry disease also lead to stroke. These monogenic disorders cause either small vessel or large vessel stroke (or a combination of both) and serve as useful models for understanding and studying conventional stroke and cerebrovascular disease and its accompaniments such as vascular dementia.