Static Neurological Conditions Flashcards
What are the three standards that apply to assessment of the neurological system?
- 49 CFR 391.41 b7 - discretionary; involves rheumatic, arthritic, orthopedic, and muscular evaluation
- 49 CFR 391.41 b8 - nondiscretionary; pertains to epilepsy
- 49 CFR 391.41 b9 - discretionary; pertains to mental disorders
Which standard that applies to assessment of the neurological system is non-discretionary?
49 CFR 391.41 b8 - nondiscretionary; pertains to epilepsy
When is use of anticonvulsant medication disqualifying?
Is disqualifying the medicine is being used to treat the patient for seizures. There’s still a risk for seizures if a dose is missed.
When is use of anticonvulsant medication not disqualifying?
If the medicine is being used to treat for psychiatric disorders or chronic pain, patient is not automatically disqualified from driving. The small doses used for chronic pain are less likely to be associated with side effects that could interfere with safe driving.
What are some side effects of anticonvulsant drugs that could interfere with safe driving?
Depressed mood, cognitive deficits, decreased reflex responses, unsteadiness, sedation.
What three conditions have to be met in order to certify a driver who takes a medication that is an anticonvulsant?
- Medication is proven to be safe and effective for the driver
- Severity of the underlying condition does not interfere with safe driving
- the medicine is not being used to treat or control seizures
Name three different reasons that a driver who is prescribed an anticonvulsant cannot be certified to drive a commercial motor vehicle.
- Medication’s side effects endanger public safety
- severity of the underlying condition interferes with safe driving
- medication is being used to treat seizures
If it is determined that driver who takes an anticonvulsant can be certified, what is the maximum certification period?
Two years
The anticonvulsant must be treating something other than epilepsy(e.g. chronic pain)
get a specialty consult when indicated
driver must have an annual medical exam
When is a driver who takes anticoagulants ineligible for certification?
Do not certify the driver if the anticoagulant is being given for a cerebral vascular disorder, because of the risk of bleeding while driving.
The certification disorder is based on underlying condition, not purely on the basis of needing an anticoagulant.
Can a driver who was otherwise medically eligible be certified if they are taking an anticoagulant because of a cardiovascular disorder?
Yes. You can certify them after the patient has been treated for at least a month and is stabilized. The patient must provide INR results during the examination.
Name four situations when a driver who was otherwise medically eligible cannot be certified because they’re taking anticoagulation.
- Anticoagulant is for a cerebrovascular disorder
- INR is not monitored
- INR is monitored, but it’s not therapeutic
- underlying disease is disqualifying
What’s the maximum time length for which a person who is on an anticoagulant be certified?
Driver can be certified for up to one year
-driver must have annual medical exams and monthly INRs
-get specialty consultation with indicated
The DOT classifies neurological conditions into three different types. Name these types.
-Static
-progressive
-episodic
How does the DOT define a static neurologic condition?
-event happens and has residual, long-lasting effects
-there is a risk that the event could recur
How does the DOT define a progressive neurologic condition?
Symptoms become more severe over time
How does the DOT define an episodic neurologic condition?
Condition occurs periodically and/or repeatedly, but not continuously
Give examples of some static neurologic conditions.
-TIA with little or no residual effect
-embolic or thrombotic stroke with moderate to major residual effects
-intracerebral or subarachnoid hemorrhage
-seizure secondary to stroke
-traumatic brain injury with or without seizure
-spinal cord injury
When is the risk of repeat TIA or stroke the greatest?
-During the first few weeks following the TIA
-after a year, risk of repeat occurrence decreases to 5%; the risk can be decreased by medical or surgical treatment
After a driver has had a TIA or a minor stroke, what requirements must be met in order to get certified?
-One year waiting period during which patient is seizure free and off medication
-normal physical exam at the time the medical examiner sees them
-normal neuro- exam including neuro- ophthalmological evaluation and neuropsychological testing
What would make a driver who has had TIA or minor stroke ineligible for certification?
-Use of oral anticoagulant therapy
-any other drug or combination of drugs with high risk of complications
If a driver who has had TIA or minor stroke is certified, how often do you have to be examined?
-Must have an annual medical exam
-minimum of annual certification, although the examiner has the discretion to certify for less than a year if they have particular concerns
When would a driver who has had an embolic or thrombotic stroke become ineligible for certification?
Driver cannot be certified if there are significant deficits that interfere with:
-attention
-cognitive ability
-concentration
-judgment
-physical strength and agility
-reaction time
-vision
Location of the stroke is directly related to potential for seizures. Strokes involving the ______ or ________ are least like to cause poststroke seizures.
cerebellum
brainstem
Location of the stroke is directly related to potential for seizures. Strokes involving ______ or _________ deficits are at greatest risk for poster seizures.
cortical
subcortical