DVLA's guide for medical professionals to help them with enquiries from the public about driving with various conditions.

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Updated: New condition 'Seizure after a period of epilepsy' has been added and amendments to 'Solitary loss of consciousness/loss of or altered awareness with seizure markers' and 'Two or more episodes loss of consciousness/loss of or altered awareness without reliable prodromal symptoms'.

How to use this guide

This guide for medical professionals to help with any enquiries from the general public about driving with various conditions. Only applies to Great Britain and Northern Ireland.

Use the A to Z navigation on the left to find specific conditions and the medical standards associated with them.

This guide is also available in a basic PDF booklet.

General advice to give to drivers

It is advised that the applicant or licence holder must notify DVLA, unless stated otherwise in the text relating to specific conditions. In some cases, a combination of multiple medical conditions, each insufficient in itself to disqualify from driving, may produce an annual risk of incapacitation unacceptable for either a Group 1 or a Group 2 licence, or render a person a likely source of danger.

When such a combination of risk factors is felt to be present, the patient should be advised not to drive. Health professionals can get additional clarification from the DVLA.

Advice for the general public

Use the ‘quick answer’ guide to search for specific health conditions and driving ‘quick answer’ guide.

S

This section covers conditions from ‘Schizophrenia’ to ‘Syncope’.

Schizophrenia

For information in relation to schizophrenia please select the relevant link below:

Acute psychosis
Chronic schizophrenia

Seatbelt Exemption

There is overwhelming evidence to show that seatbelts prevent death and serious injury in road traffic accidents. For this reason, the law makes it compulsory for car occupants to wear seatbelts, where fitted. One exception allowed by legislation is if the car occupant has a valid exemption certificate, which confirms it is inadvisable on medical grounds to wear a seatbelt. The certificates are issued by medical practitioners, who will need to consider very carefully the reasons for exemption, in view of the weight of evidence in favour of seatbelts. Medical practitioners can obtain supplies of Certificate of Exemption from Compulsory Seat Belt Wearing (product Ref PPU4272) and the guidance leaflet Medical Exemption from Compulsory Seat Belt Wearing by phoning 0300 123 1102. The certificates come in booklets of 5.

Further enquiries should be made to:

Department for Transport
Road Safety Division 1
Zone 3/21
Great Minster House
33 Horseferry Road
London
SW1P 4DR

Tel: 020 7944 2027

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Seizure after a period of epilepsy

Group 1 entitlement ODL – car, motorcycle

If an individual has demonstrated at least 5 years’ freedom from seizures and then has another seizure, they could be considered to have had an isolated seizure, for the purposes of driver licensing.

Licensing would depend upon meeting the isolated seizure standards.

Group 2 entitlement vocational – lorries, buses

If an individual has demonstrated at least 10 years’ freedom from seizures without the use of anti-epileptic medication during those 10 years and then has another seizure, they could be considered to have had an isolated seizure, for the purposes of driver licensing.

Licensing would depend upon meeting the isolated seizure standards.

This can only apply on one occasion.

Sleep apnoea

See Excessive sleepiness.

Sleep disorders - including Obstructive sleep apnoea syndrome causing excessive daytime/awake time sleepiness

The applicant or licence holder must notify DVLA unless stated otherwise in the text.

Further information can be found on the leaflet INF159: tiredness can kill

Group 1 entitlement ODL – car, motorcycle

Driving must cease until satisfactory control of symptoms has been attained.

Group 2 entitlement vocational – lorries, buses

Driving must cease until satisfactory control of symptoms has been attained, with ongoing compliance with treatment, confirmed by consultant/specialist opinion. Regular, normally annual, licensing review required.

Solitary loss of consciousness/loss of or altered awareness likely to be cardiovascular in origin

Excluding Reflex vasovagal syncope and Solitary loss of consciousness/loss of altered awareness likely to be unexplained syncope but with a high probability of reflex vasovagal syncope.

Factors indicating high risk:

  • abnormal ECG
  • clinical evidence of structural heart disease
  • syncope causing injury, occurring at the wheel or whilst sitting or lying
  • more than one episode in previous six months

Further investigations such as ambulatory ECG (48hrs), echocardiography and exercise testing may be indicated after specialist opinion has been sought.

See Pacemaker implant.

Group 1 entitlement ODL – car, motorcycle

Licence refused/revoked for 6 months if no cause identified.

Can drive 4 weeks after the event if the cause has been identified and treated.

Group 2 entitlement vocational – lorries, buses

Licence refused/revoked for 12 months if no cause identified.

Can drive 3 months after the event if the cause has been identified and treated.

See Cough Syncope.

Solitary loss of consciousness/loss of or altered awareness likely to be unexplained syncope but with a high probability of reflex vasovagal syncope

These have no clinical evidence of structural heart disease and a normal ECG.

Group 1 entitlement ODL – car, motorcycle

No driving restrictions - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

Can drive 3 months after the event.

See Cough syncope.

Solitary loss of consciousness/loss of or altered awareness with no clinical pointers

This category will have had appropriate neurological and cardiac opinion and investigations but with no abnormality detected.

Group 1 entitlement ODL – car, motorcycle

Licence refused/revoked for 6 months.

Group 2 entitlement vocational – lorries, buses

Licence refused/revoked for 1 year.

Solitary 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.

Factors to be considered:

  • without reliable prodromal symptoms
  • unconsciousness for more than five minutes.
  • amnesia longer than five minutes
  • injury
  • tongue biting
  • incontinence
  • remain conscious but with confused behaviour
  • headache post attack

Group 1 entitlement ODL – car, motorcycle

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

If a person has a history of epilepsy, an isolated seizure or a loss of consciousness/loss of or altered awareness with seizure markers within the preceding 5 years, then a period of 1 year’s freedom from any such events must be demonstrated before being considered eligible to drive

Group 2 entitlement vocational – lorries, buses

Five 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.

If a person has a history of epilepsy, an isolated seizure or a loss of consciousness/loss of or altered awareness with seizure markers within the preceding 10 years, then a period of 10 years’ freedom from any such events must be demonstrated before being considered eligible to drive.

Stroke/TIA

Group 1 entitlement ODL – car, motorcycle

TIAs

Must not drive for 1 month.

Single TIA

No need to notify DVLA.

Multiple TIAs over a short period

May require 3 months free from further attacks before resuming driving and DVLA should be notified.

Stroke

Must not drive for 1 month. May resume driving after this period if the clinical recovery is satisfactory. There is no need to notify DVLA unless there is residual neurological deficit 1 month after the episode; in particular, visual field defects, cognitive defects and impaired limb function. Minor limb weakness alone will not require notification unless restriction to certain types of vehicle or vehicles with adapted controls is needed. Adaptations may be able to overcome severe physical impairment (see Disabled drivers appendix and Appendix 2 - Forum of mobility centres.

Seizures occurring at the time of a stroke/TIA or in the ensuing 24 hours may be treated as provoked for licensing purposes in the absence of any previous seizure history or previous cerebral pathology.

Group 2 entitlement vocational – lorries, buses

Licence refused or revoked for 1 year following a stroke or TIA. Can be considered for licensing after this period provided that there is no debarring residual impairment likely to affect safe driving and there are no other significant risk factors. Licensing may be subject to satisfactory medical reports including exercise ECG testing.

Where there is imaging evidence of less than 50% carotid artery stenosis and no previous history of cardiovascular disease Group 2 licensing may be allowed without the need for functional cardiac assessment.

However, if there are recurrent TIAs or strokes functional cardiac testing shall still be required.

Subarachnoid haemorrhage

Group 1 entitlement ODL – car, motorcycle

1. No cause found

Provided comprehensive cerebral angiography normal, may resume driving following recovery. Till 70 licence.

2a. Intracranial aneurysm

NB: If any other procedure is undertaken eg VP shunt, craniotomy for a haematoma etc, then the standards for that procedure shall apply.

Craniotomy non middle cerebral artery aneurysm: drive on clinical recovery.

Craniotomy middle cerebral artery aneurysm: drive on clinical recovery.

Endovascular treatment non middle cerebral artery aneurysm: drive on clinical recovery.

Endovascular treatment middle cerebral artery aneurysm: drive on clinical recovery.

(b) No treatment (ie Aneurysm responsible for SAH but no intervention)

Six months off driving.

(c) Truly incidental findings of intracranial aneurysm (aneurysm has not been responsible for subarachnoid haemorrhage)

No treatment: drive on clinical recovery.

Surgery craniotomy: drive on clinical recovery.

Endovascular treatment: drive on clinical recovery.

Group 2 entitlement vocational – lorries, buses

1. No cause found

Provided comprehensive cerebral angiography normal, 6 months off driving and may regain licence if no debarring residual impairment likely to affect safe driving.

2(a). Intracranial aneurysm

NB: If any other procedure is undertaken eg VP shunt, craniotomy for a haematoma etc, then the standards for that procedure shall apply.

Craniotomy non middle cerebral artery aneurysm: Modified Rankin Scale (mRS) < 2 at 2 months - 12 months off driving.
Modified Rankin Scale (mRS) 2 or > at 2 months - 24 months off driving, there should be no residual impairment likely to affect driving.

Craniotomy middle cerebral artery aneurysm:
Modified Rankin Scale (mRS) < 2 at 2 months - 24 months off driving.
Modified Rankin Scale (mRS) 2 or > at 2 months - refusal or revocation. Specialist assessment required, seizure risk should be 2& p.a or less and there should be no residual impairment likely to affect driving.

Endovascular treatment non middle cerebral artery aneurysm
Modified Rankin Scale (mRS) < 2 at 2 months - 6 months off driving.
Modified Rankin Scale (mRS) 2 or > at 2 months - 24 months off driving, there should be no residual impairment likely to affect driving.

Endovascular treatment middle cerebral artery aneurysm: Modified Rankin Scale (mRS) < 2 at 2 months - 24 months off driving.
Modified Rankin Scale (mRS) 2 or > at 2 months - refusal or revocation. Specialist assessment required, seizure risk should be 2& p.a or less and there should be no residual impairment likely to affect driving.

(b) No treatment (ie Aneurysm responsible for SAH but no intervention)

Refusal or revocation.

(c) Truly incidental findings of intracranial aneurysm (aneurysm has not been responsible for subarachnoid haemorrhage)

No treatment: to be acceptable for licensing, anterior circulation aneurysms (excluding cavernous carotid) must be <13mm in diameter. Posterior circulation aneurysms must be <7mm diameter.

Surgery craniotomy: one year off driving.

Endovascular treatment: cease driving until clinical recovery unless there are complications from the procedure.

Subdural haematoma - chronic subdural

(Treated surgically).

Group 1 entitlement ODL – car, motorcycle

Resume driving on recovery.

Group 2 entitlement vocational – lorries, buses

Six months - 1 year off driving, depending on features.

Subdural haematoma - spontaneous acute

(Treated by craniotomy).

Group 1 entitlement ODL – car, motorcycle

Six months off driving.

Group 2 entitlement vocational – lorries, buses

At least 6 months off driving and shall require an individual assessment.

Subsequent cranioplasty

Group 1 entitlement ODL – car, motorcycle

Following Cranioplasty, driving may resume when clinically recovered providing there are no complications, if these occur, the appropriate licensing standard would apply. It will be necessary to consider the underlying condition which required surgery.

Group 2 entitlement vocational – lorries, buses

Minimum 6 months off and then licensing will be dependent upon the individual assessment of the underlying condition.

Successful catheter ablation

Group 1 entitlement ODL – car, motorcycle

Driving must cease for at least 2/7.

Driving may be permitted thereafter provided there is no other disqualifying condition - DVLA need not be notified.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Following successful catheter ablation for an arrhythmia that has caused or would likely have caused incapacity, driving should cease for 6/52. Driving may recommence thereafter provided there is no other disqualifying condition.

When the arrhythmia has not caused nor would likely have caused incapacity, driving may recommence after 2/52 provided there is no other disqualifying condition.

Supratentorial AVMs

See Arteriovenous malformation - supratentorial.

Syncope

NB: For Cough Syncope see Renal disorders and Respiratory disorders.

Group 1 entitlement ODL – car, motorcycle

See Loss of consciousness/loss of or altered awareness.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

See Loss of consciousness/loss of or altered awareness.

T

This section covers conditions from ‘Taxi licensing’ to ‘Two or more episodes of loss of conciousness/loss of altered awareness without reliable prodromal symptoms’.

Taxi Licensing

The House of Commons Transport Select Committee on Taxis and Private Hire Vehicles recommended in February 1995 that taxi licence applicants should pass a medical examination before such a licence could be granted.

Responsibility for determining the standards, including medical requirements, to be applied to taxi drivers, over and above the driver licensing requirements, rests with the Transport for London in the Metropolitan area and the Local Authority in all others areas. Current best practice advice is contained in the booklet ‘Fitness to Drive’: A Guide for Health Professionals published on behalf of the Department by The Royal Society of Medicine Press Limited (RSM) in 2006. This recommended that the Group 2 medical standards applied by DVLA in relation to bus and lorry drivers, should also be applied by local authorities to taxi drivers.

Caveat

The advice of the Panels on the interpretation of EC and UK legislation, and its appropriate application, is made within the context of driver licensing and the DVLA process. It is for others to decide whether or how those recommendations should be interpreted for their own areas of interest, in the knowledge of their specific circumstances.

TIA

See Stroke/TIA.

Transient arrhythmias

See Arrhythmia.

Transient global amnesia

Group 1 entitlement ODL – car, motorcycle

Provided epilepsy, any sequelae from head injury and other causes of altered awareness have been excluded, no restriction on driving. DVLA need not be notified. Till 70 licence retained.

Group 2 entitlement vocational – lorries, buses

A single confirmed episode is not a bar to driving; the licence may be retained. If 2 or more episodes occur, driving should cease and DVLA notified. Specialist assessment required to exclude all other causes of altered awareness.

Transphenoidal surgery

See Pituitary tumour.

Transplants not covered in earlier sections

Group 1 entitlement ODL – car, motorcycle

Driving may continue provided the driver is not suffering from a disqualifying condition. May need to notify DVLA depending upon underlying condition.

Group 2 entitlement vocational – lorries, buses

Driving may continue provided the driver is not suffering from a disqualifying condition. May need to notify DVLA depending upon underlying condition. May require individual assessment.

Traumatic head injury

Group 1 entitlement ODL – car, motorcycle

Usually requires 6-12 months off driving depending on features such as seizures, PTA, dural tear, haematoma and contusions. There will need to have been a satisfactory clinical recovery and in particular no visual field defect, or cognitive impairment likely to affect safe driving. See also Disabled drivers appendix and Appendix 2 - Forum of mobility centres.

Group 2 entitlement vocational – lorries, buses

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.

Two or more episodes of loss of consciousness/loss of altered awareness without reliable prodromal symptoms

Group 1 entitlement ODL – car, motorcycle

If the episodes have been within the last 5 years then licence revoked or refused for 12 months or until the risk has been reduced to <20% per annum.

Group 2 entitlement vocational – lorries, buses

If the episodes have been within the last 10 years then licence revoked or refused for 10 years or until the risk has been reduced to less than 2% per annum.

U

This section covers ‘Unpaced congenital complete heart block’.

Unpaced congenital complete heart block

Group 1 entitlement ODL – car, motorcycle

May drive if asymptomatic.

Group 2 entitlement vocational – lorries, buses

NB: A Left Ventricular Ejection Fraction of < 0.4 is considered a bar to Group 2 Entitlement.

Bars whether symptomatic or asymptomatic.


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