• Kai Michael Schubert, Giulio Bicciato, Lucia Sinka, Laura Abraira, Estevo Santamarina, José Álvarez-Sabín, Carolina Ferreira-Atuesta, Mira Katan, Natalie Scherrer, Robert Terziev, Nico Döhler, Barbara Erdélyi-Canavese, Ansgar Felbecker, Philip Siebel, Michael Winklehner, Tim J von Oertzen, Judith N Wagner, Gian Luigi Gigli, Annacarmen Nilo, Francesco Janes, Giovanni Merlino, Mariarosaria Valente, María Paula Zafra-Sierra, Luis Carlos Mayor-Romero, Julian Conrad, S Evers, Piergiorgio Lochner, Frauke Roell, Francesco Brigo, Carla Bentes, Rita Peralta, Teresa Pinho E Melo, Mark R Keezer, John Sidney Duncan, Josemir W Sander, Barbara Tettenborn, Matthias Koepp, and Marian Galovic.
• Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
• J. Neurol. Neurosurg. Psychiatr. 2024 Aug 16; 95 (9): 833837833-837.

BackgroundIn addition to other stroke-related deficits, the risk of seizures may impact driving ability after stroke.MethodsWe analysed data from a multicentre international cohort, including 4452 adults with acute ischaemic stroke and no prior seizures. We calculated the Chance of Occurrence of Seizure in the next Year (COSY) according to the SeLECT2.0 prognostic model. We considered COSY<20% safe for private and <2% for professional driving, aligning with commonly used cut-offs.ResultsSeizure risks in the next year were mainly influenced by the baseline risk-stratified according to the SeLECT2.0 score and, to a lesser extent, by the poststroke seizure-free interval (SFI). Those without acute symptomatic seizures (SeLECT2.0 0-6 points) had low COSY (0.7%-11%) immediately after stroke, not requiring an SFI. In stroke survivors with acute symptomatic seizures (SeLECT2.0 3-13 points), COSY after a 3-month SFI ranged from 2% to 92%, showing substantial interindividual variability. Stroke survivors with acute symptomatic status epilepticus (SeLECT2.0 7-13 points) had the highest risk (14%-92%).ConclusionsPersonalised prognostic models, such as SeLECT2.0, may offer better guidance for poststroke driving decisions than generic SFIs. Our findings provide practical tools, including a smartphone-based or web-based application, to assess seizure risks and determine appropriate SFIs for safe driving.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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