Medical aspects of fitness to drive a guide for medical practitioners

2.4
Epilepsy
2.4.1 Tonic clonic epilepsy
Having an epileptic seizure while driving can place the driver and other road users at
risk. In view of the risks to road safety, medical practitioners should notify the Agency
of any individual who continues to drive while still having seizures (see section 1.4).
Epilepsy does not, of itself, preclude holding a licence to drive a private motor vehicle
nor does a period of uncontrolled epilepsy automatically mean a permanent ban from
driving. The diagnosis of epilepsy in commercial drivers will generally result in them
being considered permanently unfit to drive.
Medical standards for individuals applying for or renewing a class 1 or class 6 licence and/or
a D, F, R, T or W endorsement (see appendix 3)
When driving should cease
Driving should cease if:
• an individual is having seizures or has had a seizure in the last 12 months
(although there may be exceptions to this requirement, which are discussed below)
• an individual who requires medication to prevent seizures does not comply with
medical advice about taking their medication, or undertakes activities, such as
drinking in excess, that can increase the risks of having a seizure or seizures.
When driving may resume or may occur
A period of 12 months free from seizures is normally required before an individual is
allowed to drive again or is allowed to obtain a driver licence. The Agency may reduce
this period to six months if:
• a favourable specialist report indicates that the likelihood of further seizures is
minimal
• there are favourable modifiers, such as seizures having occurred during medically
directed medication changes, seizures secondary to acute metabolic or toxic states
not likely to recur, seizures associated with reversible acute illness.
The existence of unfavourable modifiers will, in most cases, preclude any shortening of
the required 12‐month seizure‐free period. Unfavourable modifiers include:
• non‐compliance with medication or appointments and/or evidence of lack of credibility
• alcohol and/or drug abuse within the previous 12 months
• previous poor driving records and/or seizure‐related crashes in the past five years
• the presence of a structural brain lesion or non‐correctable brain or metabolic condition.
A request to be allowed to resume driving less than 12 months after the last seizure
should be made to the Chief Medical Adviser and should be accompanied by a
supporting report from a neurologist.
Individuals who have more than one seizure‐related crash should be considered using
the guidance for the commercial classes and endorsements for tonic clonic epilepsy,
except that they can take medication to control seizures during the five‐year period
they are seizure free.
During any period of withdrawal of treatment, for whatever reason, there should be a
minimum period of six months without seizures before resuming driving.
Medical standards for individuals applying for or renewing a class 2, 3, 4 or 5 licence and/or
a P, V, I or O endorsement
When driving should cease
Generally, any individuals with these licence classes or endorsements suffering from
epilepsy are normally considered permanently unfit to hold a commercial licence and
should not drive under these licence classes or endorsement types.
When driving may resume or may occur
The Agency may consider granting a licence for these classes or endorsements where:
• an individual has been seizure free for five years without taking any anti‐seizure
medication
• a neurologist’s opinion supports the application.
A request should be made to the Chief Medical Adviser and accompanied by a
supporting report from a neurologist.
2.4.2
A solitary seizure
(where epilepsy has not been established)
There is evidence that individuals who have a single seizure and who have not had
a diagnosis of epilepsy established have a high risk of having further seizures in the
future. Therefore, the treatment of a solitary seizure where the cause of the seizure is
unknown is the same as for tonic clonic epilepsy.
There may be exceptional circumstances where an individual has a single seizure
associated with a clearly identified and non‐recurring provoking cause, eg where
medication given for another condition has provoked a seizure and the medication is
discontinued. In such cases, a request should be made to the Chief Medical Adviser,
accompanied by a supporting report from a neurologist and information on the
provoking cause of the seizure.
Seizures after a head injury are discussed under section 2.10.3.
22 2. Neurological and related disorders | Medical aspects of fitness to drive | NZTA July 2009
July 2009 NZTA | Medical aspects of fitness to drive | 2. Neurological and related disorders 23