Driving and Neurological Disease
Private standard
• Applies to:
o Car
o Motorcycle
o Light rigid (LR) (Small truck 4.5 to 8 tonnes, Large Van, small bus >12 passengers)
Commercial standard
• Applies to:
o Medium rigid (MR)
o Heavy rigid (HR)
o Heavy combination (HC)
o Multiple combinations (MC)
o Drivers carrying public passengers for hire or reward (Bus, taxi, mini-bus)
o Drivers carrying bulk dangerous goods
Epilepsy and Blackout
From the Dec 2016 Guidelines:
|
|
Private vehicle |
Commercial |
|
Default after a seizure |
12 months |
10 years and normal EEG |
|
|
|
|
|
First seizure |
6 months |
5 years and normal EEG |
|
Acute symptomatic seizure |
6 months (12 months if two separate transient
disorders have occurred) |
12 months AND Normal EEG in 6 months before return to driving (and no abnormal EEGs
in last 12 months) |
|
Epilepsy |
|
|
|
-
Treated for the first time |
No seizures in last 6 months AND At lease 6 months of treatment AND If any seizures since starting Rx they occurred in first 6 months |
No reduction |
|
-
Previously well controlled (i.e. no seizures for
12 months) |
4 weeks (if clear provoking factor which has not
caused previous seizures) 3 months if no provoking factor |
No reduction |
|
-
Only ever seizures in sleep |
12 months (since first sleep seizure) |
No reduction |
|
-
Previous awake seizures but now only sleep
seizures |
2 years (since last awake seizure) AND sleep only seizures have been
occurring for at least 2 years |
No reduction |
|
-
‘Safe’ seizures (i.e. awareness and control
maintained) |
Safe seizures present >2 years AND No unsafe seizures in last 2 years |
No reduction |
|
Medication withdrawal or reduction |
During reduction and then 3 months If reduction due to dose related side effects – No restriction |
No reduction |
|
-
If a Sz during withdrawal and medication
restarted |
4 weeks once full dose of previously effective
medication restarted |
No reduction |
|
Post surgery for epilepsy |
12 months |
10 years and normal EEG (and continuing medication) |
|
If seizure causes MVA (or loss of control of
vehicle) |
12 months – no reductions allowed |
10 years – no reductions allowed |
|
Blackout |
|
|
|
-
Syncope |
No restriction if - Vasovagal,
unlikely to occur while driving If severe syncope without warning – cause
must be identified and treated and no events then for 4 weeks. |
5 Years |
|
-
Unknown cause |
6 months – for single event (or
several within 24hours) 12 months – if >1 event |
10 Years |
Childhood epilepsy syndromes
• If the patient had a benign childhood epilepsy and no seizures after the age of 11 then they can hold an unconditional licence
Review
• Annual review default
•
Can apply for unconditional licence if:
o
Seizure
free for 5 years and off medication
for 12 months
o
??Seizure
free for 10 years who are still on medication
Vision
|
|
Private vehicle |
Commercial |
|
Visual acuity |
Unconditional licence: - Uncorrected VA at
least 6/12 in best eye (or with both eyes) Conditional
licence: -
If VA
criteria met with corrective lens |
Unconditional licence: - Uncorrected VA at
least 6/9 in best eye - AND VA at least 6/18
in worse eye Conditional
licence: -
If VA
criteria met with corrective lens |
|
Visual fields |
Binocular visual field (with fixation)
at least 110 degrees within 10 degrees above and below the horizontal
midline -
From last seen spot to
last seen spot -
A scotoma of up to
three adjacent spots can be ignored AND No scotoma within the central 20 degrees of foveal fixation -
4 or more adjacent
missed spots -
3 adjacent missed
spots AND any other missed spot in central 20deg -
Any missed spots in
central 20deg that are a extension of a hemianopia or quadrantanopia of 3 or
more spots |
Binocular visual field at least 140 degrees within 10 degrees above
and below the horizontal midline AND No scotoma likely to affect driving |
|
Monocular visual loss |
At 3 months after visual loss (until adaptation to monocular vision
has occurred) |
|
|
Diplopia |
No diplopia within central 20 degrees of primary gaze (exception can be given) |
No diplopia within central 20 degrees of primary gaze |
Stroke
|
|
Private vehicle |
Commercial |
|
TIA |
2 weeks minimum |
4 weeks minimum |
|
Stroke |
4 weeks minimum |
3 months minimum |
|
SAH |
3 months |
6 months |
|
Aneurysm – see below |
|
|
Other
|
|
Private vehicle |
Commercial |
|
Aneurysm |
If high risk of symptomatic haemorrhage – cannot drive until treated. |
|
|
Head Injury |
Dependent on nature of injury or deficit |
|
|
Intracranial surgery |
6 months |
12 months |
|
Substance abuse (e.g. heavy, frequent alcohol use/dependence) |
Must be in a treatment program and in remission for at least 1 month. |
|
|
Peripheral neuropathy |
Case by case basis |
|
|
Dementia |
Case by case basis (conditional) |
|
