Makindo Medical Notes.com

Related Subjects: |First Seizure

If unsure talk to your seniors. If there is doubt then advise patient not to drive and to inform DVLA. Do not send home a patient with a fit without asking and giving advice.

The responsibilities are clear

• It is the responsibility of the driver to inform the DVLA but
• It is the responsibility of their doctors to advise patients that medical conditions (and drugs) may affect their ability to drive and for which conditions patients should inform the DVLA.
• Drivers should also inform their insurance company of any condition disclosed to the DVLA.

  AT A GLANCE GUIDE

Advise drivers not to drive and to inform DVLA

Here is a summary of some guidance for those with GROUP 1 ENTITLEMENT ODL CAR, M/CYCLE. The restrictions for those with a GROUP 2 entitlement are higher. See the at a glance document for more.

FIRST UNPROVOKED EPILEPTIC SEIZURE/SOLITARY FIT

6 months off driving from the date of the seizure unless there are clinical factors or investigation results which suggest an unacceptably high risk of a further seizure, ie. 20% or greater per annum.

EPILEPSY/EPILEPTIC SEIZURES

General guidance for ALL neurosurgical conditions if associated with epilepsy or epileptic seizures. In all cases where epilepsy has been diagnosed, the epilepsy regulations apply. These cases will include all cases of single seizure where a primary cerebral cause is present and the liability to recurrence cannot be excluded. An exception may be made when seizures occur at the time of an acute head injury or intracranial surgery.

CEREBROVASCULAR DISEASE:

Including stroke due to occlusive vascular disease, spontaneous intracerebral haemorrhage, TIA, amaurosis fugax and intracranial venous thrombosis. Must not drive for 1 month. May resume driving after this period if the clinical recovery is satisfactory. There is no need to notify DVLA unless there is a residual neurological deficit 1 month after the episode; in particular, visual field defects, cognitive defects and impaired limb function. Minor limb weakness alone will not require notification unless restriction to certain types of vehicle or vehicles with adapted controls is needed. Adaptations may be able to overcome severe physical impairment(See Appendices 1 & 2).A driver experiencing multiple TIAs over a short period may require 3 months free from further attacks before resuming driving and should notify DVLA. Epileptic attacks occurring at the time of a stroke/TIA or in the ensuing 24 hours may be treated as provoked for licensing purposes in the absence of any previous seizure history or previous cerebral pathology. Seizures occurring at the time of intracranial venous thrombosis require 6 months free from attacks before resuming driving.

ANGINA

Driving must cease when symptoms occur at rest, with emotion or at the wheel. Driving may recommence when satisfactory symptom control is achieved. DVLA need not be notified

ACUTE CORONARY SYNDROMES

(ACS) defined as:1. Unstable angina (symptoms at rest with ECG changes)2. Non-STEMI with at least two of the following criteria Symptoms at rest, Raised serum Troponin, ECG changes3. STEMI symptoms with ST-elevation on ECG if successfully treated by coronary angioplasty, driving may recommence after 1/52 provided:

• No other URGENT revascularisation is planned. (URGENT refers to within 4/52 from the acute event)
• LVEF is at least 40% prior to hospital discharge.
• There is no other disqualifying condition. If not successfully treated by coronary angioplasty, driving may recommence after 4/52 provided:
• There is no other disqualifying condition. DVLA need not be notified.

Simple Faint

Definite provocational factors with associated prodromal symptoms and which are unlikely to occur whilst sitting or lying. Benign in nature. If recurrent, will need to check the 3 P's apply on each occasion (provocation/prodrome/postural).(If not see Number 3 below).No driving restrictions. DVLA need not be notified.

Loss of consciousness/ loss of or altered awareness likely to be unexplained syncope and high risk of recurrence

Factors indicating high risk:(a) abnormal ECG(b) clinical evidence of structural heart disease(c) syncope causing injury, occurring at the wheel or whilst sitting or lying(d) more than one episode in previous six months. Further investigations such as ambulatory ECG (48hrs), echocardiography and exercise testing may be indicated after the specialist opinion has been sought.**for Pacemakers see Chapter 2 Can drive 4 weeks after the event if the cause has been identified and treated. If no cause identified, licence refused/revoked for 6 months

Loss of consciousness/ loss of or altered awareness likely to be unexplained syncope and low risk of recurrence.

These have no clinical evidence of structural heart disease and a normal ECG. Can drive 4 weeks after the event.