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According to the most recent (1991) Guide for Determining Driver Limitation, put out by the Texas MAB, there are many categories with various degrees of limitation. A bullet• has been placed by those relevant to Neurologists. An arrow identifies subjects relevant to seizures and altered consciousness. I have made comments in brackets.
GENERAL DEBILITY
Aging
Pulmonary Diseases
Malignancies
PSYCHIATRIC DISORDERS
Multiple Medical Problems
Personality Disorders
Psychoneurotic Disorders [pseudoseizures]
Psychotic Disorders
•Organic Brain Syndrome
Psychotropic Drugs
Homicidal and Suicidal Manifestations
•Mental Retardation
ALCOHOL INDUCED PROBLEMS
DRUG INDUCED PROBLEMS
EYE DEFECTS
METABOLIC DISEASES
Chronic Renal Failure
Diabetes Mellitus
For a one year period prior to the issuing of any type of license, the applicant should be free of hyperglycemia and/or hypoglycemia severe enough to a) cause neurologic dysfunction: confusion, motor dysfunction or loss of consciousness. b) result in an accident. c) require active assistance in treatment.
MUSCULOSKELETAL DEFECTS
Arthritis
•Back Pain
•Cerebral Palsy
•Cervical Spine Disorders
•Demyelinating Disorders
•Hemiplegia
•Muscle Dystrophies
CARDIOVASCULAR DISEASES
Angina
Arrhythmia
Arterial Aneurysms
Arteriosclerotic Heart Disease
Carotid Sinus Sensitivity
Must go six (6) months without a syncopal attack.
Congenital Heart Disease
Coronary Bypass Surgery
Dyspnea
Hypertension
Hypotension
Myocardial Infarction
Pacemakers
Syncope
a. Unpredictable (without warning): Precludes all driving if within one year.
b. Predictable and clearly defined (i.e. vasovagal syncope): Precludes licensure of cargo and passenger transport vehicles in class A, B and C if within one year. Modified if physician explains a definite cause not expected to recur, i.e. reflex vasovagal syncope.
Thrombophlebitis
•NEUROLOGICAL DISORDERS
Transient Cerebral Ischemic Attacks
Cerebrovascular Accident [Stroke to us Neurologists]
Narcolepsy and Excess Daytime Sleeping
Peripheral Neuropathy
Movement Disorders
Includes but not limited to Parkinsonism, torticollis, choreoathetosis and
myoclonus [non-epileptic and epileptic].
Convulsive Disorders
Convulsive disorders of all types are the most common neurological conditions impairing driving ability. Recurrent seizures are those requiring medication therapy or any seizure activity within the past ten (10) years in an applicant not taking medication. A history of recurrent seizures, epileptic or convulsive attacks precludes operation of cargo and passenger transport vehicles in classes A, B and C. Operation of personal automobiles in class C is dependent upon the following conditions:
1. Currently under a physician's care to assess control by anticonvulsant medication, drug side effects, seizure recurrence and any neurological or medical changes in condition.
2. No evidence of clinical seizures (including partial seizures) in a six (6) month observation period prior to medical review. [but what about simple partial, non-motor?]
3. Specific recommendation from applicant's physician regarding applicant's reliability in taking medications, avoiding sleep deprivation and fatigue, and avoiding alcohol abuse.
[Note: some of these recommendations are old wives tales, unsupported by scientific literature. Don't get punitive with your patients.]
4. Applicants with seizures only during sleep (i.e. no seizures ever while awake) should be allowed to operate private vehicles in class C and be re-evaluated annually.
[Note: no mention of how long the pattern of strictly nocturnal seizures has to be established. I had Pennsylvannia make it 2 years.]
5. If an applicant has a well controlled seizure disorder on medications proven by time and then has a seizure when his physician makes a medication change, he should be allowed to drive when returned to his previous medication regimen.
[Note: the physician may not want to return to the old regimen, e.g. SIADH was discovered, so it's best to advise the patient to report the seizure to the State. Even return to the old regimen doesn't guarantee continued control.]
In Texas, the DPS and Dept. Health have a physician referral form. It states:
A physician who is licensed to practice medicine in Texas may voluntarily inform the department or the board, orally or in writing, of the full name, date of birth, and address of a patient over the age of 15 years whom he or she has diagnosed as having a disorder or disability specified in the rules of the department. The release of such information by the physician to the board is an exception to the patient-physician privilege requirements of Section 5.08 of the Medical Practices Act. (f)... Physicians voluntarily reporting to the board under Subdivision (3) of Subsection (d) of this section may NOT be held liable for their professional opinions, recommendations and reports.
Vernon's Civil Statutes, Article 6687b, §21A,(3),et seq.
PROCESS
TEXAS (512) 465-2223
1. Initial drivers application screens for epilepsy with medical questions.
2. If patient answers yes they receive a medical form to have filled out by a physician.
3. Medical form is reviewed by the MAB, which was established in 1970.
The following text is on this form [my comments in brackets]:
The MAB for Driver Licensing has been requested by the Texas Dept. of Public Safety (DPS) to assist them in the evaluation of your case for possible medical limitations to driving.
In order to do this as quickly as possible, it is necessary for you to take this Medical Report form to the physician of your choice. You must then be examined at your expense and the results are to be entered by the physician on the report form and returned to us. [NOTE: The physician should not give this to the patient as it could then be altered. Make sure the patient signs the form. The physician keeps a copy.]
Immediate attention to this matter will insure your case being processed without delay. If we do not hear from you within twenty (20) days, your file must be returned to the DPS for their disposition.
[I suggest to fill this out "Dragnet" style, i.e. just the facts, ma'am]
4. Duration of seizure free interval 6 months. but exceptions made for missed AEDs and other things.
If a patient with a license has a seizure, they must report themselves and obtain a medical form.
No public campaign for citizens or physicians has ever been done to publicize these
procedures.
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