Seizures and Commercial Driving Restrictions

Gregory L. Krauss, MD

Disclosures

June 09, 2005

Question

A 48-year-old, heavy truck driver experienced an unwitnessed event about 6 months ago. The state police found him unresponsive with his truck semijackknifed on the interstate. There was a report of his being incontinent. Blood sugar was 120 mg/dL. There was no recurrence of similar spells. Brain magnetic resonance imaging (MRI) as well as routine and ambulatory electroencephalograms (EEGs) were within normal limits. Exam was nonfocal. Now he has asked to get his driver's license renewed. What should we do?

Response from Gregory L. Krauss, MD

The patient's episode should be carefully reviewed for clues that could help determine its cause. Typical findings that differentiate seizures and other conditions are gastric or psychic auras (50% of partial-onset seizures) or convulsive movements (generalized seizures); light-headedness, nausea, pallor, and collapse followed by general weakness (syncope); and prolonged confusion and complex defensive driving maneuvers (intoxication states). Many patients with major seizures report a pattern of prior complex partial seizures upon questioning. If the patient had no warning symptoms and his episode was not witnessed, additional tests may clarify the cause of his episode. Patients with epilepsy have interictal epileptogenic activity in 50% (one EEG) to 85% (three EEGs) of routine EEGs -- this patient had 2 EEGs, both of which were normal. He should have complete screening for syncope with electrocardiogram, echocardiogram, and tilt table testing.

Patients who drive large commercial vehicles and lose consciousness pose a serious safety risk to the public and should not be permitted to drive.[1] The US DOT imposes a lifelong ban on interstate commercial driving following a seizure. State restrictions on intrastate commercial driving for patients with episodic loss of consciousness vary. A growing number of states (eg, Pennsylvania and Delaware) are adopting US DOT restrictions on intra-state commercial driving. Some states apply general driving restrictions on commercial driving (eg, West Virginia restricts driving for 1 year for commercial and noncommercial drivers after seizures), or apply special restrictions on intrastate commercial driving. State driving restrictions are listed on the Epilepsy Foundation of America Web site.[2] Many large organizations have internal rules for employee driving, usually limiting commercial driving for a period of 6 months or more following an episode of loss of consciousness.

The patient should be advised to report his condition to the Department of Motor Vehicles and to adhere to his state's commercial driving restrictions. Because it will require a long time (1 year or more) to safely determine whether his episodes will recur, he may wish to seek alternative employment, possibly retraining while on short-term disability leave.

processing....