Last Updated: 09/12/2009

Changes to the AAG guide following the secretary of states honorary panel meetings

Cardiovascular Panel

CHANGES TO DRIVING STANDARDS – Following the meeting of the Secretary of State for Transport’s Honorary Medical Advisory Panel on Driving and Disorders of the Cardiovascular System held on 17 September 2009.

The following amendments to the standards in the DVLA Exercise Tolerance Test protocol for Group 2 Entitlement (VOC - LGV/PCV) for licence holders/applicants.

Should Atrial Fibrillation develop de novo during Exercise testing, provided the individual meets all the DVLA Exercise tolerance test criteria, the individual will be required to undergo an Echocardiogram and meet the licensing criteria, just as any individual with a pre-existing Atrial Fibrillation.

Neurology Panel

CHANGES TO DRIVING STANDARDS – Following the meeting of the Secretary of State for Transport’s Honorary Medical Advisory Panel on Driving and Disorders of the Nervous System held on 1 October 2009.

The following amendments to the standards for Solitary Seizure and Episodes of Loss of Consciousness/Altered Awareness with Seizure Markers were made:

NEUROLOGICAL DISORDERS

GROUP 1 ENTITLEMENT ODL – CAR, M/CYCLE

GROUP 2 ENTITLEMENT VOC – LGV/PCV

First unprovoked epileptic

Seizure/solitary fit

6 months off driving from the date of the seizure unless there are clinical factors or investigation results which suggest an unacceptably high risk of a further seizure, ie. 20% or greater per annum.

5 years off driving from the date of the seizure if the licence holder has undergone recent assessment by a neurologist and there are no clinical factors or investigation results (eg. EEG, brain scan) which indicate that the risk of a further seizure is greater than 2% per annum. They should have taken no anti-epilepsy medication throughout the 5-year period immediately prior to the granting of the licence.

For Group 2 licensing, the following features are consistent with a person having a good prognosis:

No relevant structural abnormality of the brain on imaging
No definite epileptiform activity on EEG
Support of the neurologist
Seizure risk considered to be 2% or less per annum.

NEUROLOGICAL DISORDERS

GROUP 1 ENTITLEMENT ODL – CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC – LGV/PCV

4. Presumed loss of consciousness/ loss of or altered awareness with seizure markers

This category is for those where there is a strong clinical suspicion of a seizure but no definite evidence.

The seizure markers act as indicators and are not absolutes:

- unconsciousness for more than 5 minutes

- amnesia longer than 5 minutes

- injury

- tongue biting

- incontinence

- remain conscious but with confused behaviour

- headache post-attack

6 months off driving from the date of an episode of loss of consciousness/loss of or altered awareness.

However, if a person has a previous history of epilepsy or a solitary seizure, 12 months’ freedom from any further episode of loss of consciousness with seizure markers must be attained.

If a person suffers recurrent episodes of loss of consciousness with seizure markers, 12 months’ freedom from such episodes must be attained.

5 years off driving from the date of an episode if the licence holder has undergone assessment by an appropriate specialist and no relevant abnormality has been identified on investigation, for example EEG and brain scan, where indicated.

Metastatic Deposits in the Brain:
It was confirmed that a metastatic deposit in the brain is to be regarded as equivalent to a grade 4 tumour.

NEUROLOGICAL DISORDERS

GROUP 1 ENTITLEMENT
ODL – CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC – LGV/PCV

GLIOMAS & MALIGNANT

TUMOURS (including metastatic deposits)

Supratentorial

Grade 1 and 2

1 year off driving, dating from completion of the primary treatment of the tumour.

Permanent refusal or revocation.

Grade 3 and 4

Metastatic deposits to be treated as a grade 4 tumour

2 years off driving after treatment, although some drivers may require a longer period.

NB. When a low grade glioma is an incidental finding and asymptomatic, the case can be considered on an individual basis for Group 1 driving.

Permanent refusal or revocation.

Infratentorial tumours

Grade 1

As for benign tumours: ie. drive on recovery.

Individual assessment.

Grades 2, 3 & 4

As for supratentorial tumour.

Permanent refusal or revocation.

Medulloblastoma or low grade ependymoma

If totally excised, can be considered for licensing 1 year after primary treatment, if free from recurrence.

If entirely infratentorial, can be considered for licensing when disease-free for 5 years after treatment.

High grade ependyomamas, other primary malignant brain tumours.

Normally, a period of 2 years off driving is required following treatment.

Permanent refusal or revocation.

Solitary metastatic deposit

If totally excised, can be considered for licensing 1 year after primary treatment if free from recurrence and no evidence of secondary spread elsewhere in the body.

Permanent refusal or revocation.

MALIGNANT INTRACRANIAL TUMOURS IN CHILDREN WHO SURVIVE TO ADULT LIFE WITHOUT RECURRENCE

Normally, a till 70 licence is issued/maintained.

Individual assessment: see above as for ‘Benign Supratentorial Tumour’.

Minor changes were made to the standards for significant head injury without surgery.

NEUROLOGICAL DISORDERS

GROUP 1 ENTITLEMENT
ODL – CAR, M/CYCLE

GROUP 2 ENTITLEMENT
VOC - LGV/PCV

Significant Head Injury

Usually requires 6-12 months off driving depending on features such as seizures, PTA, dural tear, focal signs and also on clinical recovery.

Refusal or revocation. May be able to return to driving when the risk of seizure has fallen to no greater than 2% per annum, and with no debarring residual impairment likely to affect safe driving.