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
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Section 7:
Diseases of the Nervous System

Conclusions

The literature reviewed above suggests that both narcolepsy and obstructive sleep apnea may be associated with impaired driving performance. However, the limitations in the current literature are such that recommendations regarding licensure are likely to be based on an inadequate knowledge base. As noted by the American Thoracic Society (1994), sleep apnea is "undoubtedly a risk factor, but is not invariably linked with impaired driving" (p. 1466). Thus, "efforts to reduce excessive driving risk should most sensibly be directed at selected patients with excessive daytime sleepiness, rather than categorically applied to anyone with apnea or with a certain number of sleep apnea events" (p. 1466). For example, results from Findley et al. (1988) reveal that more than two thirds of individuals with sleep apnea were crash free during a five-year study period. Currently used measures of disease severity are inadequate in identifying those individuals with sleep apnea most at-risk for motor vehicle crashes. Research is needed that will identify those individuals with sleep apnea who are most at-risk for motor vehicle crashes. Finally, research examining the relationship between simulated driving performance and on-road performance is needed. Currently, that relationship is not well defined.

Table 21  Guidelines for Diseases of the Nervous System (Reproduced with permission)

Guidelines for Diseases of the Nervous System (Drivers of Private Vehicles)

Condition/ lllness

Austroads (1998)

CMA (2000)

Seizures

Auras

Not addressed.

Drive if there is no impairment in level of consciousness and cognition, the seizures are unchanged for more than one year, and a neurologist approves.

Single, Unprovoked Seizure Before a Diagnosis

Isolated Seizure
Should not drive for 3-6 months. Consultant opinion recommended.

Not drive for at least 3 months and until a complete neurological examination including EEG and CT have been conducted to determine cause.

After Epilepsy Diagnosis

Recently Diagnosed Epilepsy:

  1. Should not drive until seizure free for 3-6 months from start of therapy.
  2. Consultant opinion recommended.

A conditional license may be issued by the DLA on medical advice.

Drive if:

  1. 12 months seizure free and on medication*
  2. Physician has insight into patient compliance.
  3. Physician cautions against fatigue, alcohol use.

*The 12- month period may be reduced to 6 months on the recommendation of a neurologist.

After Surgery to Prevent Epileptic Seizure

Not addressed.

Resume driving if 12 months seizure free after surgery*

*The 12-month period may be reduced to 6 months on the recommendation of a neurologist.

Chronic Epilepsy (History of Previously Controlled Seizures)

  1. Should not drive for up to 2 years.
  2. Consultant opinion recommended.

A conditional license may be issued by the DLA on medical advice.

See ‘After Epilepsy Diagnosis’ section.

Medication Withdrawal or Change

  1. Initial Withdrawal or Change
  2. If Seizures Recur After Withdrawal or Change
  3. Long-Term Withdrawal and Discontinuation of Medication
  1. When consultant opinion suggests significant risk of recurrent seizure, driving should cease during withdrawal and for at least 3 months thereafter.
  2. Should not drive for 1 month after resuming previously effective medication or for 2 years if refusing to resume medication.
  3. Not addressed.
  1. Not drive for a period of 3 months from the time medication has been discontinued or changed.
  2. Resume driving if takes medication according to the physician’s instructions and is seizure free for 6 months (can reduce period if neurologist agrees). Drive any vehicle if seizure-free off medication for 5 years.

Alcohol Withdrawal Induced Seizures

Not addressed.

  1. May drive if individual: remains alcohol-free and seizure-free for 12 months, and
  2. Completes a recognized rehabilitation program for substance dependence.

Syncope

Unpredictable, spontaneous loss of consciousness is incompatible with safe driving.

A single episode of syncope/fainting of unknown cause renders an individual unable to drive for at least 4 weeks after the event. Recurrent events require a specialist opinion.

A single occurrence that is fully explained and unlikely to recur may require no more than careful observation.

Individuals who have a history of a number of fainting spells or repeated unexplained falls should not drive until the cause has been determined and corrective measures taken.

Sleep Disorders

Narcolepsy

Should not drive until disorder fully investigated and treated and report considered by DLA.

Patients with a diagnosis of narcolepsy supported by a sleep study and with an episode of cataplexy in the past 12 months (with or without treatment) should not drive any type of motor vehicle.

Sleep Apnea

Should not drive. DLA may issue conditional license if condition stable. Annual review and neurologist opinion recommended.

Obstructive Sleep Apnea:
Patients with obstructive sleep apnea documented by a sleep study that are compliant with CPAP and UPPP treatments should be safe to drive any type of motor vehicle.

Patients with moderate to severe obstructive sleep apnea documented by sleep study who are non-compliant with treatment should not drive any type of motor vehicle.

Patients with obstructive sleep apnea who are believed compliant with treatment and who are subsequently involved in a motor vehicle crash should not drive for at least 1 month after the motor vehicle crash. During this one- month period, their compliance must be reassessed. After the one-month period, they may or may not drive depending on the results of reassessment.

CPAP

= Continuous Positive Airway Pressure

UPPP

= Uvulopalato-pharyngoplasty

DLA

= Driver Licensing Authority

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