Physical Qualification Standards and Advisory Criteria - Neurological Flashcards
Waiting period for anticoagulant therapy
1 month stabilized INR
Must provide a copy of INR results and have at least monthly monitoring
Max certification period for a patient on anticoagulants
1 year
Recommend not to certify a driver on anticoagulants if…
The driver has an underlying cerebrovascular disorder
Can you certify a driver who is on anticonvulsant therapy?
Only if nature and severity of the underlying condition does not interfere with safe driving and effects of medication used while operating a CMV does not endanger the driver or the public
When should you disqualify a driver on anticonvulsants?
If the anticonvulsant meds are used to control or prevent seizures
The risk for subsequent unprovoked seizures is greatest when?
In the first 2 years following an acute brain insult
For the entire waiting period following seizure, the driver should be…
Seizure free
Off anticonvulsant meds for the control of seizures
When should you apply a 1 year waiting period for seizures?
Mild insult w/o early seizures
Stroke w/o risk for seizures
Intracerebral or subarachnoid hemorrhage w/o risk for seizures
Must be seizure free and off anticonvulsants for the entire 1 year waiting period
When should you apply a 2 year waiting period for seizures?
Moderate insult w/o early seizures
Mild insult with early seizures
Must be seizure free and off anticonvulsants for the entire 2 year waiting period
When should you apply a 5 year waiting period for seizures?
Moderate insult with early seizures
Stroke with risk for seizures
Intracerebral or subarachnoid hemorrhage with risk for seizures
Must be seizure free and off anticonvulsants for the entire 5 year waiting period
How long can a driver with history of seizures be certified for?
1 year, if:
Driver with a hx of mild or moderate insult who has:
- Completed the min waiting period seizure free and off meds
- Normal PE, neuro exam, and neuropsycho test
- Clearance from a neurologist
For seizures caused by metabolic dysfunction, is there a specific waiting period?
No. Can certify for up to 2 years provided the underlying systemic metabolic dysfunction has been corrected and driver has no disqualifying risk or recurrence
Can a driver with childhood seizures be certified?
Yes, for up to 2 years, provided seizures were limited to childhood febrile seizures
Following an unprovoked seizure, the driver should be seizure free and off anticonvulsants for at least _____ to distinguish between a medical history of a single seizure and epilepsy.
5 years
If a driver has a second seizure following an unprovoked seizure, regardless of the elapsed time…
That would constitute a medical history of epilepsy and driver would no longer be eligible for certification.
Waiting period for drivers with history of unprovoked seizure
10 years off anticonvulsants and seizure free provided they have no established medical history or diagnosis of epilepsy
Recommend to certify a driver with a single unprovoked seizure if …
Completed the minimum 5 year waiting period seizure free and off anticonvulsants
Clearance by neurologist
Can a driver with vertigo be certified?
Yes, with 2 mo waiting period asymptomatic with dx of BPPV or acute or chronic peripheral vestibulopathy
Do not certify a driver for dizziness/vertigo if the driver has a diagnosis of…
BPPV with symptoms in the last 2 mo Acute/chronic peripheral vestibulopathy with symptoms in the last 2 mo Meniere's disease Labyrinthine fistula Nonfunctioning labyrinths
When can you apply a 1 year waiting period for CNS infections?
1 year seizure free and off anticonvulsants for:
Bacterial meningitis w/o early seizures
Viral encephalitis w/o early seizures
When can you apply a 5 year waiting period for CNS infections?
5 years seizure free and off anticonvulsants for
Bacterial meningitis with early seizures
When can you apply a 10 year waiting period for CNS infections?
10 years seizure free and off anticonvulsant meds for
Viral encephalitis with early seizures
Does a driver with a history of aseptic meningitis require a waiting period?
No
Do not certify a driver with autonomic neuropathy who has…
Cardiovascular autonomic neuropathy causing resting tachycardia or orthostatic BP
Other organ autonomic neuropathy that interferes with driving ability
For drivers with abnormal muscle activity, do not certify a driver who has a diagnosis of…
Myotonia
Isaac’s Syndrom
Stiff-man syndrome
Can a driver with a congenital myopathy be certified?
No
These include central core disease, centronuclear myopathy, congenital muscular dystrophy, rod (nemaline) myopathy
Can a driver with a metabolic muscle disease be certified?
Nope
Can a driver with a motor neuron disease be certified?
Nope
How about muscular dystrophy? Can a driver with that be certified
NOPE
Neuromuscular junction disease (ie myasthenia gravis)
They can’t drive either. It’s a damn shame.
Peripheral neuropathy?
They can’t drive either
What type of CNS tumors need a 1 year waiting period?
1 year post surgical removal of... Intratentorial meningiomas Acoustic neuromas Pituitary adenomas Spinal benign tumors Benign extra-axial tumors
What type of CNS tumors need a 2 year waiting period?
2 years post surgical removal of…
Benign supratentorial tumors
Spinal tumors
Max certification period for a driver with a CNS tumor?
1 year certification following 1 or 2 year waiting period after removal
Has to have stable nonprogressive deficit or no neuro deficit
Imaging must show no tumors
Can a driver with dementia be certified?
Hell no
Waiting period for embolic and thrombotic strokes
1 year if not at risk for seizures (cerebellum or brainstem vascular lesions)
5 years if at risk for seizures (cortical or subcortical deficits)
Max certification for embolic/thrombotic strokes
1 year, provided:
- Waiting period complete
- Normal PE, neuro exam including neuro-ophthalmological eval and neuropsych testing
- No neuro residuals, or if present severity that doesn’t interfere with driving
- Clearance by a neurologist
Waiting period following intracerebral and subarachnoid hemorrhages
1 year if not at risk for seizures
5 years if at risk for seizures
Max certification following intracerebral and subarachnoid hemorrhages
1 year, same requires as for embolic/thrombotic strokes
How about waiting period for TIAs?
Same as the other types of stroke:
1 year if not at risk for seizures
5 years if at risk for seizures
Max certification after TIAs
1 year
What is the best predictor of future risk of seizures following TBI?
The length of time an individual is seizure free and off anticonvulsant meds
A waiting period of 2 years seizure free and off anticonvulsants is appropriate for what type of TBIs?
Moderate TBI w/o early seizures
Mild TBI with early seizures
A waiting period of 5 years seizure free and off anticonvulsants is appropriate for what type of TBIs?
Moderate TBI with early seizures
Max certification following TBI
1 year, unless it was a mild TBI without early seizures (that gets 2 years)
See page 166 for a great table
What did I just say?!
