Medical Conditions and Driving: A Review of the Literature (1960  2000)
TRD Page
Foreword
Acknowledgements
Section1: Introduction
Section 2: Vision
Section 3: Hearing
Section 4: Cardiovascular
Section 5: Cerebrovascular
Section 6: Peripheral Vascular
Section 7: Nervous System
Section 8: Respiratory
Section 9: Metabolic
Section 10: Renal
Section 11: Musculoskeletal
Section 12: Psychiatric
Section 13: Drugs
Section 14: Aging Driver
Section 15: Anesthesia and Surgery
Appendix A
List of Tables
List of Figures
download PDF

Appendix A
Preliminary Guidelines for Physicians:
Assessing Medical Fitness-to-Drive

Section 7: Diseases of the Nervous System

  1. Auras and Focal Seizures
  2. Single Unprovoked Seizure
  3. Withdrawal or Change of Anti-Epileptic Drug Therapy
    1. If seizures recur after withdrawal or change of medication
  4. Seizures while Asleep
  5. Sleep Disorders
    1. Narcolepsy
    2. Sleep Apnea
  6. Other Neurologic Conditions
    1. Dementia
    2. Parkinson's Disease
    3. Multiple Sclerosis
    4. Migraines
    5. Brain Tumors
    6. Peripheral Neuropathy

Preliminary Guidelines for Medically-At-Risk Drivers
Section 7: Diseases of the Nervous System

Condition

1. Auras and Focal Seizures

No driving until seizure free for 6 months. Time period may be shortened upon approval of specialist (see unfavorable/favorable modifiers below).

2. Single Unprovoked Seizure

Should not drive for 6 months. Time period may be shortened with specialist approval.

Predictors of recurrent seizures that would preclude shortening of time interval are:

  1. If previous seizure was focal in origin.
  2. If focal or neurologic deficits predated the seizure.
  3. If seizure is associated with chronic diffuse brain dysfunction.
  4. A positive family history of epilepsy.
  5. The presence of generalized spike waves or focal spikes on EEG recordings.

Favorable modifiers:

  1. Seizures during medically directed medication changes (see below).
  2. Simple partial seizures that do not interfere with level of consciousness and/or motor control.
  3. Seizures with consistent and prolonged auras.
  4. Established pattern of pure nocturnal seizures.
  5. Seizures secondary to acute metabolic or toxic states not likely to recur.
  6. Sleep deprived seizures.
  7. Seizures related to reversible acute illness.

Unfavorable modifiers:

  1. Non-compliance with medication or medical visits and/or lack of credibility.
  2. Alcohol and/or drug abuse in the past 3 months.
  3. Increased number of seizures in past year.
  4. Prior bad driving record.
  5. Structural brain lesion.
  6. Non-correctable brain functional or metabolic condition.
  7. Frequent seizures after seizure free interval.
  8. Prior crashes due to seizures in the past 5 years.

3. Withdrawal or Change of
     Anti-Epileptic Drug Therapy

  1. If seizures recur after withdrawal or change of medication

When physician suggests significant risk of recurrent seizure, driving should cease during withdrawal or change and for at least 3 months thereafter. Should not drive for 1 month after resuming previously effective medication or for 6 months if refusing to resume medication and individual is seizure free during that time period.

4. Seizures while Asleep

A person who has suffered an attack while asleep should refrain from driving for 6 months from the date of the attack. However, the time period may be shortened at the advice of a specialist (i.e., 3 months) if an established pattern of pure nocturnal seizures is evident.

5. Sleep Disorders:

a. Narcolepsy

Should cease driving on diagnosis. Driving may be permitted when satisfactory control of symptoms achieved.

b. Sleep Apnea

Driving permitted when satisfactory control of symptoms achieved.

6. Other Neurological Conditions

a. Dementia

Recommendations from the Canadian Consensus Conference on Dementia:

  1. Physicians should consider risks associated with driving in every patient for whom they treat dementia or cognitive impairment.
  2. Focused medical assessments that include history of driving difficulty from a family member or friend, and an exam focused on cognitive abilities such as memory, attention, reaction time, judgment, and visuospatial abilities is recommended. Physicians should be alerted that driving difficulties may indicate other cognitive/functional problems that need to be addressed.
  3. Physicians should encourage patients with AD and related dementias, along with their caregivers, to plan early for eventual cessation of driving privileges and develop transportation support to those who lose their capacity to drive.
  4. Physicians are advised to notify their driver licensing agency regarding the patient’s competence to drive, even in those provinces/states that have not mandated reporting by physicians, unless the patient gives up driving voluntarily.
  5. Physicians should advocate for the establishment and access to affordable, validated performance-based driving assessments and transportation programs.

Serial evaluations are recommended every 6-12 months because of the progressive nature of disease.

b. Parkinson’s Disease

Driving may be permitted based on outcome of assessment for level of symptom involvement, response to treatment, and likelihood of freezing or dyskinesias. Serial evaluations are recommended every 6-12 months because of progressive nature of disease.

c. Multiple Sclerosis

Assessment by specialist and driving assessor recommended.

d. Migraines

Individuals with recurrent migraines should be cautioned about driving when experiencing neurologic manifestations (e.g., visual disturbances,dizziness).

e. Brain Tumors

Driving recommendation will depend on type of tumor, prognosis, rate of growth, type of treatment, seizures, cognitive or perceptual impairments.

f. Peripheral
   Neuropathy

If difficulty with proprioception or sensation is identified, a driver rehabilitation specialist can assist in selecting appropriate vehicle controls so that driving can be maintained.



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