TEXAS LAWS REGARDING DRIVING
The laws determining safety of driving in medical conditions are extensive, but review of those pertinent to neurology follows below:
· Syncope
o Unexplained syncope
§ A single episode if unexplained precludes driving for 6 months. If cause is found and corrected, driving may resume with physician permission.
o Neurocardiogenic syncope
§ If uncontrolled and frequent and occurs while driving, precludes class A, B, and C passenger or cargo vehicle licensure until controlled for 6 months.
o Recurrent uncontrolled syncope
§ Precludes class A, B, and C passenger or cargo vehicle licensure until controlled for 1 year.
§ Recurrent means 2 or more episodes in 6 months.
· Transient ischemic attacks (TIA)
o If the event was caused by circumstances not likely to recur, it is permissible to drive with class A, B, or unrestricted C license.
o If patients are treated with appropriate anticoagulant therapy, they may resume driving.
o If a patient is not on anticoagulant therapy or the underlying cause is not known, a 1 month driving restriction should follow the last known episode of TIA.
· Blackouts
o Temporary loss of consciousness, of which the person has no recall, often associated with alcohol or drug intoxication.
o 6 month driving restriction
· Stroke
o Patients should demonstrate driving ability through DPS comprehensive driving test in moderate to severe motor, sensory, visual or language impairment.
· Convulsive disorders
o For all seizures types: May obtain a class C license with P restriction after 3 months of seizure freedom
§ For a class A, B, or unrestricted C license, must be seizure free OFF seizure medication for a period of 5 years.
§ For patients with simple partial sensory seizures, the 3 months of restriction is not required.
o For all of the above patients with seizures, driving is dependent upon other factors
§ The patient is under a physician’s care.
§ No evidence of seizures in the last 3 months.
§ The patient is reliable in taking medications, avoiding sleep deprivation and fatigue, and avoiding alcohol abuse.
§ If the patient has well controlled epilepsy, but has a seizure with a change in medications, driving may be resumed when the patient returns to the previous dose of seizure medications.
· Dementia
o Diagnosis of dementia precludes driving unless the individual is judged to be safe by:
§ A Neuropsychological evaluation of cognitive abilities involved in driving.
§ A driving evaluation by a center or persons trained to evaluate driving ability in the setting of cognitive impairment.
§ Medical assessment by a physician with expertise in evaluating attention, memory, language, etc in a standardized way.
§ If none of the above options are available, passing the DPS written and driving evaluation will be acceptable.
o Drivers who pass the initial evaluation should be re-evaluated every 12 months or sooner if concerns are raised.
· Head injury
o While the condition is under investigation, there should be no driving.
o Driving after head injury is dependent upon residual deficits.
§ If minimal – no restrictions
§ If mild – driving evaluation is required
§ If moderate (significant deficits with potential for improvement) – must pass written and driving portion of the DPS testing
§ If severe (no potential for improvement) – no driving
· Movement disorders
o Driving test recommended for moderate to severe cases
o Yearly medical board advisory review recommended.
· Multiple Sclerosis
o Comprehensive driving evaluation by a trained driving rehabilitation specialist if warranted by physician.
· Excessive sleepiness
o It is the personal responsibility of drivers to avoid driving if they are unable to maintain alertness while behind the wheel.
o Sleep apnea
§ Severe OSA (AHI>20) precludes class A, B, and C license until the sleep disorder is treated and the person demonstrates ongoing compliance with therapy.
§ Moderate sleep apnea (AHI 10-20) may drive class C if he has EDSS<10 and the OSA is being effectively treated.
§ Mild OSA (AHI <10) may drive with any license type if EDSS is <10.
§ Drivers with AHI>10 or EDS >10 must pass a Maintenance of Wakefulness Test before getting a class A or B license.
§ Ceasing therapy should be accompanied by driving cessation.
§ Those with moderate to severe OSA should be recertified annually.
§ Drivers with OSA should not be certified for unrestricted driving if:
· They have had a MCV associated with falling asleep
· Have not yet been treated for OSA successfully.
· Have been non-compliant with treatment.
§ Drivers treated with surgery but be re-evaluated prior to return to driving.
o Narcolepsy
§ Precludes driving if untreated.
§ If treated, must be free of spells for 3 month period prior to medical review.
· Peripheral neuropathy
o Driver proficiency test recommended for severe neuropathy.
· Vertigo and dizziness
o Avoid driving while symptomatic or if the dizziness is severe.
o Unqualified for driving a commercial vehicle if the patient is on benzodiazepines or phenothiazines.