DVLA and Neurological Disorders Flashcards
DVLA and Specific Rules re Neurological Disorders
The guidelines below relate to car/motorcycle use unless specifically stated. For obvious reasons, the rules relating to drivers of heavy goods vehicles tend to be much stricter
Specific rules
first seizure: 6 months off driving*. For patients with established epilepsy they must be fit free for 12 months before being able to drive
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
craniotomy e.g. For meningioma: 1 year off driving**
pituitary tumour: craniotomy: 6 months; trans-sphenoidal surgery ‘can drive when there is no debarring residual impairment likely to affect safe driving’
narcolepsy/cataplexy: cease driving on diagnosis, can restart once ‘satisfactory control of symptoms’
chronic neurological disorders e.g. multiple sclerosis, motor neuron disease: DVLA should be informed, complete PK1 form (application for driving licence holders state of health)
*previously rule was 12 months. It is now 6 months off driving if the licence holder has undergone assessment by an appropriate specialist and no relevant abnormality has been identified on investigation, for example EEG and brain scan where indicated
**if the tumour is a benign meningioma and there is no seizure history, licence can be reconsidered 6 months after surgery if remains seizure free
DVLA and Syncope
Syncope
simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
DVLA and Alzheimer’s: Example Question
A 78 year old man is brought to see you in clinic by his daughter. He has a diagnosis of Alzheimer’s dementia and although currently coping well, has significantly impaired short-term memory.
Currently his daughter attends daily for all meals, cleaning, and shopping. He continues to live in his own home and is alone overnight. She has however become concerned as he continues to drive 5 miles three times a week and she is unsure if this is safe. Which of the following is the best course of action regarding his driving licence?
He is disqualified from driving He is allowed to drive, but only if daughter is present There is no need to contact the DVLA, continue to drive > Assess his risk factors, report to the DVLA and await advice He is safe if his mini mental state examination score >11
The DVLA guidance states this is a difficult decision to make. The presence of impaired short term memory, disorientation or loss of insight suggest someone with dementia is not fit to drive.
In this case the correct answer would be to contact the DVLA, assess the risk factors and take further advice. He should not be immediately disqualified; he warrants a more careful assessment and decision with support from the DVLA. The factors that suggest someone with dementia may not be safe to drive include significantly impaired short term memory, poor attention and concentration, and impairment of planning.
DVLA and Transient Global Ischaemia - Example Question
DVLA guidelines for transient global amnesia are that as long as epilepsy, any sequelae from head injury and other causes of altered awareness have been excluded, there are no restrictions on driving and the DVLA need not be informed.
Example Question:
A 60 yr old woman went swimming with her family, and after finishing her swim and having a shower, her daughter noted that she became confused suddenly, repetitively asking if they had gone for a swim today. She could not remember events that occurred in the past 24 hours, and when told the answers to her questions, would ask the same question 5 minutes later. There was no change in her personality, no change in her speech, nor any muscle weakness. She is able to recall her address, the names of her daughters and husband, and her date of birth.
Her daughter said her mother did not suffer any trauma during the swim, and did not lose consciousness anytime throughout the day. The patient’s past medical history includes hypertension and depression, and she takes ramipril 2.5mg once daily, and citalopram 20mg once daily.
On examination the patient was alert, but constantly asked where she was and why was she in hospital. She was afebrile, heart rate 80 bpm, blood pressure 138/68 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 99% on air. Neurological examination was unremarkable, but her abbreviated mental test score was 6/10.
Her investigation results were as follow:
C Reactive protein 4 mg/l Haemoglobin 14.8 g/dl White cell count 5.6 x 10^9/L Na+ 142 mmol/l K+ 4.3 mmol/l Urea 4.2 mmol/l Creatinine 68 µmol/l Corrected calcium 2.32 mmol/l Plasma glucose 5.8 mmol/l
Computer Tomography (CT) head scan No acute intracranial pathology.
Over the next 12 hours, her memory improves and she is discharged from the observation ward.
What is the best advice for the patient with regards to driving in the future?
She can drive 4 weeks after the event if the cause has been identified and treated > DVLA need not be notified, no driving restrictions She must be symptom free for 1 year before being eligible to drive DVLA must be informed, and her licence will be revoked for 6 months She must cease driving until there is satisfactory control of her symptoms
This lady has suffered an episode of transient global amnesia, a neurological condition characterised by acute short term memory loss, lasting no more than 24 hours. Patients often developed perseveration, with repetitive questioning as they are unable to keep short term memory, but are able to recall long term memories. The aetiology of this condition is unknown.
