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

Unexplained syncope

§  A single episode if unexplained precludes driving for 6 months. If cause is found and corrected, driving may resume with physician permission.

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.

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)

If the event was caused by circumstances not likely to recur, it is permissible to drive with class A, B, or unrestricted C license.

If patients are treated with appropriate anticoagulant therapy, they may resume driving.

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

Temporary loss of consciousness, of which the person has no recall, often associated with alcohol or drug intoxication.

6 month driving restriction

·  Stroke

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.