Driving & Entitlements
The Medical Fitness to Drive Guidelines "Slainte agus Tiomaint/ (March 2015)
These medical guidelines are issued by the Road Safety Authority (see www.rsa.ie) for all medical conditions including epilepsy, These guidelines deal with group 1 licences (cars, light vans, motorcycles) and also group 2 licences (Heavy goods vehicles, buses, large vans etc). The National Driver Licensing Service co-ordinates all aspects of driver licensing see (www.ndls.ie)
The guidelines relating to epilepsy explain how the person with epilepsy will be licenced in Ireland. The guidelines give more clarity on the responsibilities of the driver, the health professional and the driving licence authority. (NDLS) The driver has responsibility to disclose during the term of a licence and health professionals have responsibility to report a driver who is not compliant or who is a public safety risk.
The relevant sections are Chapter 2 pages 18-20 and the Appendix section for Epilepsy Standards pages 44-46
The section below relating to Group 1 Licencing for cards, light vans and motorcycles is from page 44 of the guidelines
Epilepsy Standards for Group 1 :-
1. A person who has suffered an epileptic attack whilst awake must refrain from driving for at least one year from the date of the attack: driving cannot resume until the driver has had no further seizures while awake for a 12-month period.
2. A person who has experienced seizures exclusively while asleep may be considered for a one year licence despite continuing seizures only during sleep, and subject to at least annual review, taking into account information provided by the treating doctor (with appropriate expertise and due consultation as required) as to whether the following criteria are met:•There have been no previous seizures while awake; and •The first sleep-only seizure was at least 12 months ago; and •The person follows medical advice, including adherence to medication if prescribed. or•There have been previous seizures while awake but not in the preceding one year; and •Sleep-only seizures have been occurring for at least one year; and •The person follows medical advice, including adherence to medication if prescribed. and in both cases
I. So far as practicable, the person complies with advised treatment and check-ups for epilepsy,
II.The driving of a vehicle by such a person should not be likely to cause danger to the public.
A specific exception to these are seizures a judged by the treating consultant neurologist as not impairing consciousness or driving ability at any time. An annual licence may be granted by the National Driver Licence Service (NDLS) subject to at least annual review, taking into account information provided by the treating consultant as to whether the following criteria are met:
• Seizures not impairing consciousness or driving ability at any time have been present for at least one year; and
There have been no seizures of other type for at least one year; and
• The person follows medical advice, including adherence to medication if prescribed.
Break through seizures
Below is the guidance for clinicians advising patients to cease driving in the case of break-through seizures in those with established epilepsy
Group 1 Drivers:In the event of a seizure, the driver must be advised not to drive unless they are able to meet the conditions of the asleep concessions. The patient must be advised to notify the NDLS. In exceptional cases (e.g. seizure secondary to prescribing error), a consultant may advise a return after a shorter period.Guidance for withdrawal of antiepileptic medication being withdrawn on specific medical advice for Group 1 Drivers: (N .B . This advice only relates to treatment for epilepsy) From a medico-legal point of view, the risk of further epileptic seizures occurring during this therapeutic procedure should be noted. If an epileptic seizure does occur, the patient will need to satisfy driving licence standards before resuming driving and will need to be counselled accordingly. The current epilepsy standards require a period of at least one year free of any manifestation of epileptic seizure or attacks whilst awake from the date of the last attack; special consideration is given where attacks have occurred only whilst asleep.
It is clearly recognised that withdrawal of antiepileptic medication is associated with a risk of seizure recurrence. A number of studies have shown this, including the randomised study of antiepilepsy drug withdrawal in patients in remission, conducted by the UK Medical Research Council Anti-epileptic Drug Withdrawal Study Group in the UK17. This study shows a 30% risk of seizure in the first year of withdrawal ofmedication compared with those who continued on treatment.Patients undergoing withdrawal of antiepilepsy medications should be warned of the risk they run, both of needing to cease driving and also of having a seizure which could result in a road traffic accident. Patients should be advised not to drive from commencement of the period of withdrawal and thereafter for a period of 6 months after cessation of treatment. A person remains as much at risk of seizure associated with drug withdrawal during the period of withdrawal as in the 6 months after withdrawal.
17.Bonnett LJ, Shukralla A, Tudur-Smith C, Williamson PR, Marson AG. Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRC Antiepileptic Drug Withdrawal Study and a systematic review. J Neurol Neurosurg Psychiatry. 2011 Dec;82(12):1328-33.
This advice may not be appropriate in every case. One specific example is withdrawal of antiepileptic medication when there is a well-established history of seizures only while asleep. In such cases, any restriction in driving is best determined by the consultant concerned, after considering the history. It is up to the driver to comply with such advice.It is important to remember that the epilepsy standards are still relevant even if epileptic seizures occur after medication is omitted, for example on admission to hospital for any condition .
Provoked or acute symptomatic seizures may be dealt with on an individual basis if there is no previous seizure history. Seizures associated with alcohol or drug misuse, sleep deprivation or a structural abnormality is not considered provoked for licensing purposes . Similarly, reports of seizures as a side-effect of prescribed medication do not automatically imply that such events should be considered as provoked . For seizure(s) with alcohol or illicit drugs, please see Chapter 6 in these Guidelines.Doctors may wish to advise patients that the period of time likely to be recommended off driving will be influenced inter alia by:
A.Whether it is clear that the seizure had been provoked by a stimulus which does not convey any risk of recurrence and does not represent an unmasking of an underlying liability;
B. Whether the stimulus had been successfully/appropriately treated or is unlikely to occur at the wheel.In the absence of any previous seizure history or previous cerebral pathology, the following seizures may also be treated as provoked:
Convulsive syncope. •
Seizure in first week following a head injury (see head injury section) at the time of a Stroke/TIA or within the ensuing 24 hours.•
During intracranial surgery or in the ensuing 24 hours.
The Epilepsy Standards for Group 2 (HGV's, buses, large vans ) are on page 45
Epilepsy Standards for Group 2
During the period of 10 years immediately preceding the date when the licence is granted the applicant/licence holder should:
1)be free from any epileptic attack AND
2)have not taken medication to treat epilepsy AND
3)not otherwise be a source of danger whilst driving.In addition, someone with a structural intracranial lesion who has an increased risk of seizures will not be able to drive vehicles of this group until the risk of a seizure has fallen to no greater than 2% per annum, which permits compliance with the standards.