1 Neurological Disorders - DVLA Assessing Fitness to Drive Guide

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
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The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.

Advice for medical professionals for drivers with neurological disorders.

X - Must not drive! - May continue to drive subject to medical advice and/or notifying the DVLA√ - May continue to drive and need not notify the DVLA

Epilepsy

Epileptic seizures are the most common medical cause of collapse at the wheel.

Appendix B sets out the epilepsy regulations in current legislation.

The following definitions apply:

  • epilepsy encompasses all all seizure types, including major, minor and auras
  • if within a 24-hour period more than one epileptic event occurs, these are treated as a single event for the purpose of applying the epilepsy regulations.

The following features, in both Group 1 car and motorcycle and Group 2 bus and lorry drivers, are considered to indicate a good prognosis for a person under care for a first unprovoked or isolated epileptic seizure:

  • no relevant structural abnormalities on brain imaging
  • no definite epileptiform activity on EEG
  • support of a neurologist
  • annual risk of seizure considered to be 2% or lower for bus and lorry drivers.
 Group 1
Car and motorcycle
Group 2
Bus and lorry
Epilepsy or multiple unprovoked seizuresX- Must not drive and must notify the DVLA.

Provided the licence holder or applicant satisfies the regulations, a review licence will usually be issued.

If there have been no seizures for 5 years (with medication if necessary), and no other disqualifying condition, a 'til 70 licence is usually restored.
X- Must not drive and must notify the DVLA.

The person with epilepsy must remain seizure-free for 10 years (without epilepsy medication) before licensing may be considered.
First unprovoked epileptic seizure/isolated seizureX- Must not drive and must notify the DVLA.

Driving will be prohibited for 6 months from the date of the seizure.

Clinical factors that indicate that there may be an increased risk of seizures require the DVLA not to consider licensing until after 12 months from the date of the first seizure.
X- Must not drive and must notify the DVLA.

Driving will be prohibited for 5 years from the date of the seizure.

If, after 5 years, a neurologist has made a recent assessment and clinical factors or investigation results (for example, EEG or brain scan) indicate no annual risk greater than 2% of a further seizure, the licence may then be restored.

Such licensing also requires that there has been no need for epilepsy medication throughout the 5 years up to the date of the licence being restored.

If the prospective annual risk of further seizure is greater than 2%, the epilepsy regulations may apply.
Secondary causes of seizureX- Must not drive and must notify the DVLA.

In all cases of an epilepsy diagnosis, the epilepsy regulations apply to Group 1 car and motorcycle drivers.

This includes all cases of single seizure in which a primary cerebral cause is present and the likelihood of recurrence cannot be excluded.

When seizures have occurred at the time of an acute head injury or intracranial surgery these may be excepted from the epilepsy regulations.

When seizures have occurred at the time of an intracranial venous thrombosis there must be 6 months without seizure before driving may resume.
X- Must not drive and must notify the DVLA.

In all cases in which a 'liability to epileptic seizure' – either primary or secondary – has been diagnosed, the specific epilepsy regulations apply for Group 2 bus and lorry drivers.

The only possible exception is a seizure that occurred immediately at the time of an acute head injury or intracranial surgery, not some time after, and/or 'no liability to seizure' has been demonstrated.

If there is an annual risk of seizure following head injury or intracranial surgery, it must have fallen to 2% or lower before the DVLA may license bus or lorry driving.
Withdrawal of epilepsy medication! - See the special considerations below, and Appendix B gives full guidance on withdrawing epilepsy medication.! - See the special considerations below, and Appendix B gives full guidance on withdrawing epilepsy medication.
Provoked seizures (except related to use of alcohol or illicit drugs)! - See the special considerations below.! - See the special considerations below.
Dissociative seizuresX- Must not drive and must notify the DVLA.

Licensing may be considered once episodes have been satisfactorily controlled for 3 months and there are no relevant mental health issues. If there are high risk features, 6 months may be required with a specialist opinion.
X- Must not drive and must notify the DVLA.

Licensing may be considered once episodes have been satisfactorily controlled for 3 months and there are no relevant mental health issues. If there are high risk features, 6 months may be required with a specialist opinion.
Seizure following an epilepsy-free periodX- Must not drive and must notify the DVLA. The epilepsy regulations must apply.X- Must not drive and must notify the DVLA. The epilepsy regulations must apply.
Two unprovoked seizures more than 5 years apart! - The epilepsy regulations will apply.! - The epilepsy regulations will apply.
Lesional epilepsy! - In cases of a seizure due to a structural lesion, the epilepsy regulations will apply.In cases of a seizure due to a structural lesion, the epilepsy regulations will apply.

Special considerations under the epilepsy regulations

Group 1 car and motorcycle

The following special considerations apply under the epilepsy regulations for drivers of cars and motorcycles:

  1. The person with epilepsy may qualify for a driving licence if they have been free from any seizure for 1 year. This needs to include being free of minor seizures and epilepsy signs such as limb jerking, auras and absences. Episodes not involving a loss of consciousness are included.
  2. The person who has had a seizure while asleep must stop driving for 1 year from the date of the seizure unless point 3 or 5 apply.
  3. Relicensing may be granted if the person, over the course of at least 1 year from the date of the first sleep seizure, establishes a history or pattern of seizures occurring only ever while asleep.
  4. If a pattern of seizures is established for 1 year in which there is no influence on the level of consciousness and no influence on the ability to act, a continued licence may be allowed, provided the person also shows no history of any other type of unprovoked seizure.
  5. If a pattern of 3 years of purely asleep seizures after a period of awake or awake and asleep can be demonstrated, a licence can be issued

Overriding all of the above considerations is that the licence holder or applicant with epilepsy must not be regarded as a likely source of danger to the public while driving and that they are compliant with their treatment and follow up.

If the licensed driver has any epileptic seizure, they must stop driving immediately unless considerations 2, 3 or 4 can be met, and they must notify the DVLA.

If a licence is issued under consideration 3 or 4 and the driver has a different type of seizure, they lose the concession, must stop driving, and must notify the DVLA.

Isolated seizures

The person who has a first unprovoked epileptic seizure (isolated seizure) will usually qualify for a driving licence if they are free from any further seizure for 6 months. This is provided there are no other clinical factors or results of investigations that may increase the risk of a further seizure, in which case 12 months is required before driving may be relicensed.

Withdrawal of epilepsy medication (also see Appendix B)

Individuals should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose.

If a seizure occurs as a result of a physician-directed reduction or change in epilepsy medication, the epilepsy regulations state that a licence must be revoked for 12 months. Relicensing may be considered earlier than this if treatment has been reinstated for 6 months, provided there was no further seizure in the 6 months after restarting the prescription.

Group 2 bus and lorry

Drivers of buses and lorries must satisfy all of the following conditions under the epilepsy regulations. They must:

  • hold a full ordinary driving licence
  • have been free of epileptic seizures for the last 10 years
  • not have taken any epilepsy medication during these 10 years (there are thus no special considerations for withdrawal)
  • have no continuing liability to epileptic seizures

Isolated seizure

Drivers of buses and lorries must satisfy all of the following conditions in relation to an isolated seizure. They must:

  • hold a full ordinary driving licence
  • have been free of epileptic attacks for the last 5 years
  • not have taken any epilepsy medication during these 5 years
  • have undergone a recent assessment by a neurologist
  • have received satisfactory results from investigations.

Transient loss of consciousness ('blackouts') – or lost/altered awareness

Transient loss of consciousness (TLoC) or 'blackout' is very common – it affects up to half the population in the UK at some point in their lives. An estimated 3% of A&E presentations and 1% of hospital admissions are due to TLoC.

Road traffic collisions resulting from blackouts are two or three times more common than those resulting from seizures.

Recurrent TLoC (more than one isolated event), not including syncope, is uncommon – but always requires detailed medical assessment.

There are several causes of transient loss of consciousness:

In relation to TLoC, three features are of note to medical practitioners:

  • provocation
  • posture
  • prodrome.

With concern for road safety, however, the two most important features are:

  • prodrome – are there warning signs sufficient in both nature and duration?
  • posture – do the episodes of TLoC occur while sitting?

A prodrome must allow time for a driver to find a safe place to stop before losing consciousness. A prodrome is reliable if the signs are clear, consistent across all events and provide sufficient duration to find a safe stop, or unreliable if these are absent.

Licence holders or applicants should be informed that they must notify the DVLA when TLoC occurs while sitting.

For syncope occurring while standing or sitting, the following factors indicate high risk:

  • abnormal ECG
  • clinical evidence of structural heart disease

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

Transient loss of consciousness – solitary episode

Blackout with seizure markers

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Typical vasovagal syncope with reliable prodrome
While standing√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
While sittingX- Must not drive for 1 month and must notify the DVLA.X- Must not drive for 3 months and must notify the DVLA.
Syncope with avoidable trigger or reversible cause
(see cough syncope)
While standing√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
While sittingX- Must not drive for 4 weeks.

Driving may resume after 4 weeks only if the cause has been identified and treated.

Must notify the DVLA if the cause has not been identified and treated.
X- Must not drive for 3 months.

Driving may resume after 3 months only if the cause has been identified and treated.

Must notify the DVLA if the cause has not been identified and treated.
Unexplained syncope, including syncope without reliable prodrome
This diagnosis may apply only after appropriate neurological and/or cardiological opinion and investigations have detected no abnormality.
While standing or sittingX- Must not drive and must notify the DVLA.

If no cause has been identified, the licence will be refused or revoked for 12 months.
X- Must not drive and must notify the DVLA.

If no cause has been identified, the licence will be refused or revoked for 10 years.
Cardiovascular, excluding typical syncope
While standing or sittingX- Must not drive and must notify the DVLA.

Driving may be allowed to resume after 4 weeks if the cause has been identified and treated.

If no cause has been identified, the licence will be refused or revoked for 6 months.
X- Must not drive and must notify the DVLA.

Driving may be allowed to resume after 3 months if the cause has been identified and treated.

If no cause has been identified, the licence will be refused or revoked for 12 months.
This category is for those where on the balance of probability there is clinical suspicion of a seizure but no definite evidence. Individuals will require assessment by an appropriate specialist and investigation, for example EEG and brain scan, where indicated.

The following factors indicate a likely seizure:

♦ loss of consciousness for more than 5 minutes
♦ amnesia longer than 5 minutes
♦ injury
♦ tongue biting
♦ incontinence
♦ post ictal confusion
♦ headache post attack
While standing or sittingX- Must stop driving and notify the DVLA. 6 months off driving from the date of the episodeX- Must stop driving and notify the DVLA. 5 years off driving from the date of the episode.

Transient loss of consciousness – recurring episodes

Recurrent episodes of TLoC are less common than isolated episodes but the relevance to increased risk in driving cannot be overemphasised.

Recurrent TLoC is most commonly due to recurrent syncope, occurring in around 20% to 30% of patients. Recurrence of syncope is usually within three years of the first episode, and in over 80% of these cases there has been at least one additional episode within two years of the first episode.

With concern for road safety the two most important features of temporary loss of consciousness are:

  • prodrome – are there warning signs sufficient in both nature and duration?
  • posture – do the episodes of TLoC occur while sitting?

A prodrome must allow time for a driver to find a safe place to stop before losing consciousness. A prodrome is reliable if the signs are clear, consistent across all events and provide sufficient duration to find a safe stop, or unreliable if these are absent.

Licence holders or applicants should be informed that they must notify the DVLA when transient loss of consciousness occurs while sitting.

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Typical vasovagal syncope with reliable prodrome
While standing√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
While sittingX- Must not drive and must notify the DVLA.

Must not drive until annual risk of recurrence is assessed as below 20%.
X- Must not drive and must notify the DVLA.

Must not drive until annual risk of recurrence is assessed as below 2%.
Syncope with avoidable trigger or reversible cause
(see cough syncope)
While standing√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
While sittingX- Must not drive for 4 weeks.

Driving may resume after 4 weeks only if the cause has been identified and treated.

Must notify the DVLA if the cause has not been identified and treated.
X- Must not drive for 3 months.

Driving may resume after 3 months only if the cause has been identified and treated.

Must notify the DVLA if the cause has not been identified and treated.

For syncope occurring while standing or sitting, the following factors indicate high risk:

  • abnormal ECG
  • clinical evidence of structural heart disease

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

Cough syncope or presyncope

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Unexplained syncope, including syncope without reliable prodrome
This diagnosis may apply only after appropriate neurological and/or cardiological opinion and investigations have detected no abnormality.
While standing or sittingX- Must not drive for 4 weeks but need not notify the DVLA.

Driving may resume after 4 weeks.
X- Must not drive for 6 months and must notify the DVLA.
Cardiovascular but excluding typical vasovagal syncope
While standing or sittingX- Must not drive and must notify the DVLA.

Driving may resume after 4 weeks only if the cause has been identified and treated.

If no cause has been identified, the licence will be refused or revoked for 6 months.
X- Must not drive and must notify the DVLA.

Driving may resume after 3 months only if the cause has been identified and treated.

If no cause has been identified, the licence will be refused or revoked for 12 months.
Blackout with seizure markers
This category is for those where on the balance of probability there is clinical suspicion of a seizure but no definite evidence. Individuals will require assessment by an appropriate specialist and investigation, for example EEG and brain scan, where indicated.
While standing or sittingX- Must stop driving and notify the DVLA.

The standards for epilepsy will apply
X- Must stop driving and notify the DVLA.

The standards for epilepsy will apply.
 X- Must not drive and must notify the DVLA.

Must not drive for 6 months following a single episode and for 12 months following multiple episodes over 5 years.

Reapplication may be considered at any point if all of the following can be satisfied:

♦ any underlying chronic respiratory condition is well controlled
♦ smoking cessation
♦ body mass index is below 30
♦ gastro-oesophageal reflux is treated
X- Must not drive and must notify the DVLA.

Must not drive for 5 years from the date of the last episode.

Reapplication may be considered after 1 year if the all the following can be satisfied:

♦ any underlying chronic respiratory condition is well controlled
♦ smoking cessation
♦ body mass index is below 30
♦ gastro-oesophageal reflux is treated
♦ confirmation of these by a specialist doctor

Primary/central hypersomnias – including narcolepsy

For other causes of excessive sleepiness, see Chapter 8 (miscellaneous conditions).

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

A licence may be reissued only after between 3 and 6 months of satisfactory symptom control with appropriate treatment.

If not requiring treatment, relicensing may be considered after satisfactory objective assessment of maintained wakefulness, such as the Osler test.
X- Must not drive and must notify the DVLA.

Relicensing may be considered subject to satisfactory objective assessment, performed by a specialist, of maintained wakefulness, such as the Osler test.

Chronic neurological disorders – including multiple sclerosis and motor neurone disease

Any chronic neurological disorder that may affect vehicle control because of impaired coordination and muscle strength.

For information on in-car driving assessments for those with a disability, see Appendix G.

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - Must notify the DVLA.

May continue to drive as long as safe vehicle control is maintained at all times.

A licence valid for 1, 2 or 3 years may be issued provided medical enquiries by the DVLA and an assessment confirm that driving performance is not impaired.

The licence may specify a restriction to cars with certain controls.
! - Must notify the DVLA.

May continue to drive as long as safe vehicle control is maintained at all times.

A licence will be refused or revoked if the condition is progressive or disabling.

If driving is not impaired and the underlying condition is stable, licensing will be considered on an individual basis subject to satisfactory medical reports and annual review.

Parkinson's disease

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - Must notify the DVLA.

May drive as long as safe vehicle control is maintained at all times.

If the condition is disabling and/or there is clinically significant variability in motor function, the licence will be refused or revoked.

If driving is not impaired, licensing will be considered subject to satisfactory medical reports and assessment.

A licence may be issued subject to regular review.
! - Must notify the DVLA.

May drive as long as safe vehicle control is maintained at all times.

If the condition is disabling and/or there is clinically significant variability in motor function, the licence will be refused or revoked.

If driving is not impaired, licensing will be considered subject to satisfactory medical reports and assessment.

A licence may be issued subject to annual review.

Dizziness – liability to sudden and unprovoked or unprecipitated episodes of disabling dizziness

Sudden is defined as 'without warning' and disabling is defined as 'unable to continue with the activity being performed'.

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive on presentation and must notify the DVLA.

When satisfactory control of symptoms has been achieved, relicensing may be considered for restoration of the 'til 70 licence.
X- Must not drive on presentation and must notify the DVLA.

If there are sudden and disabling symptoms, the licence will be refused or revoked.

If an underlying diagnosis is likely to cause recurrence, the patient must be asymptomatic and completely controlled for 1 year from an episode before reapplying for their licence.

Stroke and Transient Ischaemic Attack (TIA) – including amaurosis fugax

For Group 2 bus and lorry drivers, the guidance is the same whether concerning stroke, or single or multiple Transient Ischaemic Attack (TIA).

 Group 1
Car and motorcycle
Group 2
Bus and lorry
StrokeX- Must not drive but may not need to notify the DVLA.

Driving may resume after 1 month if there has been satisfactory clinical recovery.

The DVLA does not need to be notified unless there is residual neurological deficit 1 month after the episode and, in particular:

♦ visual field defects
♦ cognitive defects and impaired limb function

Minor limb weakness alone after a stroke will not require notification to the DVLA unless restriction to certain types of vehicle or adapted controls may be needed. With adaptations, severe physical impairment may not be an obstacle to driving.

Seizures occurring at the time of a stroke or TIA, or in the ensuing 24 hours, may be treated as provoked for licensing purposes, provided there is no previous history of seizure or cerebral pathology.
X- Must not drive and must notify the DVLA.

A licence will be refused or revoked for 1 year following a stroke or TIA.

Relicensing after 1 year may be considered if:

♦ there is no debarring residual impairment likely to affect safe driving and
♦ there are no other significant risk factors.

Licensing may be subject to a satisfactory medical report, including results of exercise ECG testing.

If imaging evidence shows less than 50% carotid artery stenosis and there is no previous history of cardiovascular disease, a licence may be issued without the need for functional cardiac assessment.

Patients with recurrent TIAs or strokes will be required to undergo functional cardiac testing.
Single transient ischaemic attackX- Must not drive for 1 month but need not notify the DVLA.
Multiple transient ischaemic attackX- Must not drive and must notify the DVLA.

Multiple TIAs over a short period will require no driving for 3 months.

Driving may resume after 3 months if there have been no further TIAs.

Carotid artery stenosis

Group 1
Car and motorcycle
Group 2
Bus and lorry
√- May drive and need not notify the DVLA.! - Should not drive unless, in the view of an appropriate healthcare professional, it is safe to do so. Must notify DVLA.

If the level of stenosis is severe enough to warrant surgical or radiological intervention, the requirements for exercise or other functional test must be met – see Appendix C

Acute encephalitic illness and meningitis – including limbic encephalitis associated with seizures

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and may need to notify the DVLA.

a. If there are no seizures, may resume driving after complete clinical recovery and need not notify the DVLA unless there is residual disability.
b. If seizures occur during an acute febrile illness, the DVLA must be notified and will refuse or revoke a licence for 6 months, after which a 'till 70 licence may be reissued.
c. If seizures occur during or after convalescence, the DVLA must be notified and will refuse or revoke a licence until the epilepsy regulations are met, (see Appendix B)
X- Must not drive and may need to notify the DVLA.

a. If there are no seizures, may resume driving after complete clinical recovery and need not notify the DVLA unless there is residual disability.
b. If seizures occur during an acute febrile illness, the DVLA must be notified and will require freedom from seizures without anticonvulsant medication:
♦ for 5 years in meningitis cases
♦ for 10 years in encephalitis cases.
c. If seizures occur during or after convalescence, the DVLA must be notified and will refuse or revoke a licence until the epilepsy regulations are met, (see Appendix B)

Transient global amnesia

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May drive provided epilepsy, any sequelae from head injury and other causes of altered awareness have been excluded.

The DVLA does not need to be notified and a 'till 70 licence may be retained.
! - Driving is not barred by a single confirmed episode, and the licence may be retained. Driving should stop if two or more episodes occur, and the DVLA must be notified.

Specialist assessment will be required to exclude all other causes of altered awareness.

Arachnoid cysts

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Asymptomatic and no need for treatment√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
Treated by craniotomy and/or endoscopicallyX- Must not drive for 6 months and must notify the DVLA.X- Must not drive and must notify the DVLA.

Relicensing may be considered after 2 years following treatment, provided there is no debarring residual impairment likely to affect safe driving.

Colloid cysts

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Asymptomatic and no need for treatment√- May drive and need not notify the DVLA.! - Must notify the DVLA.

May drive unless prophylactic medication for seizures is prescribed, in which case an individual assessment will be required.
Treated by craniotomy and/or endoscopically! - Should not drive for 6 months but need not notify the DVLA.X- Must not drive and must notify the DVLA.

Relicensing may be considered after 2 years following treatment, provided there is no debarring residual impairment likely to affect safe driving.

Pituitary tumour

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Treated by craniotomy! - Should not drive and must notify the DVLA.

Driving may resume after 6 months provided there is no visual field defect.

If there is visual field loss, see visual disorders.
X- Must not drive and must notify the DVLA.

Driving will remain prohibited for 2 years.
No need for treatment, or treated by transsphneoidal surgery or therapy such as drugs or radiotherapy! - Should not drive but need not notify the DVLA.

Driving may resume on recovery provided there is no debarring visual field defect.
! - Should not drive but need not notify the DVLA.

Driving may resume on recovery provided there is no debarring visual field defect.

Benign brain tumours

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Benign supratentorial tumour (WHO grade I meningioma, for example)
Treated by craniotomyX- Must not drive but need not notify the DVLA.

Driving may resume after 6 months provided there is no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply if there is relevant seizure history.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

In the absence of any seizures and with evidence of complete tumour removal, relicensing may be considered 5 years after the surgery.

If the tumour is associated with seizure, relicensing will not be considered until 10 years after surgery, provided these years are free from seizures without epilepsy medication.

Specialist assessment may be required.
Treated by stereotactic radiosurgery! - Should not drive unless, in the view of an appropriate healthcare professional, it is safe to do so. Need not notify the DVLA.

Driving may resume after 1 month provided there is no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply if there is relevant seizure history.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Provided there is evidence of stability on imaging, relicensing may be considered 3 years from completion of the primary tumour treatment.

If the tumour is associated with seizure, relicensing will not be considered until 10 years after surgery, provided these years are free from seizures without epilepsy medication.

Specialist assessment may be required.
Treated by fractionated radiotherapy! - Should not drive unless, in the view of an appropriate healthcare professional, it is safe to do so. Need not notify the DVLA. Driving may resume on completion of treatment provided there is no debarring residual impairment likely to affect safe driving. The epilepsy regulations (see Appendix B) apply if there is relevant seizure history.X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Provided there is evidence of stability on imaging, relicensing may be considered 3 years from completion of the primary tumour treatment.

If the tumour is associated with seizure, relicensing will not be considered until 10 years after surgery, provided these years are then free from seizures without epilepsy medication.

Specialist assessment may be required.
WHO grade II meningiomas treated with craniotomy and/or radiosurgery and/or radiotherapy
 X- Must not drive and must notify the DVLA

Driving may resume 1 year after completion of treatment.

The epilepsy regulations (see Appendix B) apply if there is relevant seizure history.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

In the absence of any seizures and with evidence of complete tumour removal, the DVLA may consider relicensing 5 years after the surgery.

If the tumour is associated with seizure, relicensing will not be considered until 10 years after surgery, provided these years are then free from seizures without epilepsy medication.
Asymptomatic incidental meningiomas not needing treatment
 √- May drive and need not notify the DVLA.X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered after 2 scans performed 12 months apart show no growth.

Individual assessment will be considered if such lack of growth cannot be demonstrated.

Licences are reissued with annual review.

Malignant brain tumours – including metastatic deposits and pineal tumours

The standards will apply to first occurrence, recurrence and progression.

Supratentorial

 Group 1
Car and motorcycle
Group 2
Bus and lorry
WHO grade I and II gliomaX- Must not drive and must notify the DVLA.

Driving may resume 1 year after completion of primary treatment.

Where there is imaging evidence of tumour recurrence or progression licensing may be considered if:

♦ there has been a 1 year seizure free period
♦ there is no clinical disease progression.

These will apply whether or not chemotherapy has been given.

A 1 year license will usually be considered.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.

Except grade I pineocytoma: relicensing may be considered on an individual basis 2 years after primary treatment, provided MRI imaging is satisfactory.
WHO grade III meningiomaX- Must not drive and must notify the DVLA.

Driving may resume 2 years after the completion of primary treatment.
X- Must not drive and must notify the DVLA. The licence will be refused or revoked permanently.
WHO grade III or IV gliomas, multiple metastatic deposits or primary CNS lymphomaX- Must not drive and must notify the DVLA.

Driving may resume at least 2 years after the completion of primary treatment.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Solitary metastatic depositX- Must not drive and must notify the DVLA.

Relicensing may be considered 1 year after completion of the primary treatment if there was complete excision, and provided there is no recurrence or evidence of metastasis.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.

Infratentorial

 Group 1
Car and motorcycle
Group 2
Bus and lorry
WHO grade I gliomaX- Must not drive and must notify the DVLA.

Driving may resume on recovery.
X- Must not drive and must notify the DVLA.

Relicensing will be considered on individual assessment.
WHO grade II, III or IV gliomaX- Must not drive and must notify the DVLA.

Driving may resume 1 year (grade II) or 2 years (grades III and IV) after the completion of primary treatment.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Medulloblastoma or low-grade ependymomaX- Must not drive and must notify the DVLA.

Relicensing may be considered 1 year after completion of the primary treatment if there was complete excision, and provided there is no recurrence.
X- Must not drive and must notify the DVLA.

Relicensing may be considered 5 years after completion of the primary treatment, provided this period is clinically disease-free, the tumour was entirely infratentorial and completely excised.
High-grade ependymomas, other primary malignant brain tumours and primary CNS lymphomasX- Must not drive and must notify the DVLA.

Relicensing may be considered normally only after 2 years from completion of the primary treatment.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Brain metastasesX- Must not drive and must notify the DVLA.

Relicensing may be considered 1 year after completion of the primary treatment if the patient is otherwise well.
X- Must not drive and must notify the DVLA.

Relicensing may be considered 5 years after completion of the primary treatment.
Malignant intracranial tumour in childhood: survival without recurrence! - May apply to drive (or continue to drive) but must notify the DVLA.

A 'till 70 licence is normally granted or maintained.
X- Must not drive and must notify the DVLA.

Licence may be granted or reissued based on individual assessment.
Incidental, asymptomatic low-grade gliomas on imagingX- Must not drive and must notify the DVLA.

There will be an individual assessment for licensing and any licence will initially be under regular, usually annual, review.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered after 1 year if annual clinical assessment is satisfactory and subsequent specialist opinion is that the lesion is not actually a glioma.
Benign infratentorial tumours

For example, meningioma treated with craniotomy with or without radiotherapy.
X- Must not drive but need not notify the DVLA.

Driving may resume on recovery from treatment.
X- Must not drive but need not notify the DVLA.

Driving may resume on recovery from treatment provided that there is no debarring residual impairment likely to affect safe driving.

Acoustic neuroma/schwannoma

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May drive and need not notify the DVLA unless there is sudden and disabling giddiness.! - May drive and need not notify the DVLA unless there is sudden and disabling giddiness and/or the condition is bilateral.

Brain biopsy – showing undetermined histology

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Treated by craniotomy and/or endoscopicallyX- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 months if there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after a minimum of 6 months depending on individual assessment of the underlying condition.

Traumatic brain injury

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

Relicensing may be considered usually after 6 to 12 months dependent on features such as seizures, post-traumatic amnesia, dural tear, haematoma and contusions.

There will need to have been satisfactory clinical recovery and in particular no visual field defects or cognitive impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Driving may be relicensed after the annual risk of seizure has fallen to 2% or below and provided no debarring residual impairment is likely to affect safe driving.
Driving can be considered at 3 months if:

♦ there is full clinical recovery
♦ there are no seizures
♦ there is no post traumatic amnesia lasting more than 24 hours
♦ there is no intracranial haematoma and/or contusions seen on radiology.

Subdural haematoma

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Spontaneous acute subdural haematoma
Treated by craniotomyX- Must not drive and must notify the DVLA.

Driving may resume 6 months after treatment.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after at least 6 months from treatment and will require an individual assessment.
Chronic subdural haematoma
Treated surgically! - Should not drive but need not notify the DVLA.

Driving may resume on recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 to 12 months from treatment depending on individual features.

With any procedure, if another is also undertaken (for example, a ventriculoperitoneal shunt, a craniotomy for a haematoma), the standards for that procedure also apply, and may take precedence.

Subarachnoid haemorrhage

 Group 1
Car and motorcycle
Group 2
Bus and lorry
With no cause found
 !- Should not drive but need not notify the DVLA.

Driving may resume following clinical recovery provided comprehensive cerebral angiography is normal. The DVLA will issue a 'till 70 licence.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 months provided comprehensive cerebral angiography is normal and no debarring residual impairment is likely to affect safe driving.
With intracranial aneurysm
With aneurysm cause but intervention not currently needed! - Should not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
With intracranial aneurysm – non-middle cerebral artery
Treated by craniotomyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 1 year if the patient scored below 2 on the Modified Rankin Scale (MRS) at 2 months.

If the MRS score is 2 or higher at 2 months, relicensing will not be considered until after 2 years, and will require no debarring residual impairment likely to affect driving.
With intracranial aneurysm
Treated endovascularlyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 months if the patient scored below 2 on the Modified Rankin Scale (MRS) at 2 months.

If the MRS score is 2 or higher at 2 months, relicensing will not be considered until after 2 years, and will require no debarring residual impairment likely to affect driving.
With intracranial aneurysm – middle cerebral artery
Treated by craniotomyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 2 years if the patient scored below 2 on the Modified Rankin Scale (MRS) at 2 months.

If the MRS score is 2 or higher at 2 months, the licence will be refused or revoked. Relicensing will not be considered until after at least 2 years and a specialist assessment. Annual seizure risk should be no greater than 2% and there should be no residual impairment likely to affect driving.
Treated endovascularlyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 2 years if the patient scored below 2 on the Modified Rankin Scale (MRS) at 2 months. If the MRS score is 2 or higher at 2 months, the licence will be refused or revoked.

Relicensing will not be considered until after at least 2 years and a specialist assessment. Annual seizure risk should be no greater than 2% and there should be no residual impairment likely to affect driving.

Intracranial aneurysm – truly incidental finding without haemorrhage

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Treatment not currently neededX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered if:

♦ an aneurysm in the anterior circulation (excluding cavernous carotid) is less than 13 millimetres in diameter
♦ an aneurysm in the posterior circulation is less than 7 millimetres in diameter.
Treated by craniotomyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 1 year.
Treated endovascularlyX- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery.
X- Must not drive but need not notify the DVLA.

Driving may resume following clinical recovery provided there are no complications from the procedure.

Arteriovenous malformation (AVM)

With any of the procedures, if another is also undertaken (for example, a ventriculoperitoneal shunt or a craniotomy for a haematoma) the standards for that procedure also apply and may take precedence.

Supratentorial

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Intracerebral haemorrhage due to supratentorial AVM
Treatment not currently neededX- Must not drive but need not notify the DVLA.

Driving may resume after 1 month provided there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Treated by craniotomyX- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 months if there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered after 10 years free of seizure since the last definitive treatment and the lesion was completely removed or ablated. There must be no debarring residual impairment likely to affect safe driving.
Treated by embolisationX- Must not drive but need not notify the DVLA.

Driving may resume after 1 month provided there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked. Relicensing may be considered after 10 years free of seizure since the last definitive treatment and the lesion was completely removed or ablated.

There must be no debarring residual impairment likely to affect safe driving.
Treated by strereotactic radiotherapyX- Must not drive but need not notify the DVLA.

Driving may resume after 1 month provided there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered after 5 years free from seizure since the last definitive treatment and if the lesion was completely removed or ablated. There must be no debarring residual impairment likely to affect safe driving.
Incidental finding of supratentorial AVM (with no history of intracranial bleed)
Treatment not currently needed√- May drive and need not notify the DVLA.X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Treated by surgery or other modeX- Must not drive and must notify the DVLA.

Will require a period of time off driving depending on treatment and as per the relevant section.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered after 10 years free of seizure since the last definitive treatment and the lesion was completely removed or ablated.

There must be no debarring residual impairment likely to affect safe driving.

Infratentorial AVM

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Intracranial haemorrhage due to infratentorial AVM
Treatment not currently needed! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Treated by craniotomy! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered without the need for review on confirmation of complete obliteration provided there is no debarring residual impairment likely to affect safe driving.
Treated by embolisation or stereotactic radiotherapy! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered without the need for review on confirmation of complete obliteration provided there is no debarring residual impairment likely to affect safe driving.
Incidental finding of infratentorial AVM
Treatment not currently needed√- May drive and need not notify the DVLA.X- Must not drive and must notify the DVLA.

Relicensing may be considered on an individual assessment..
Treated by surgery or other mode! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered without the need for review on confirmation of complete obliteration provided there is no debarring residual impairment likely to affect safe driving.

Dural arteriovenous fistula

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

Relicensing may be considered on an individual assessment.
X- Must not drive and must notify the DVLA.

Relicensing may be considered on an individual assessment.

Cavernous malformation

There is no firm evidence of greater morbidity with multiple cavernomas, and size is not important.

Supratentorial

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Incidental finding√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
With seizure, no surgical treatmentX- Must not drive and must notify the DVLA.

The epilepsy regulations (see Appendix B) apply if there is a history of seizure.
X- Must not drive and must notify the DVLA.

The epilepsy regulations (see Appendix B) apply if there is a history of seizure.
With haemorrhage and/or focal neurological deficit, no surgical treatment! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked permanently.
Treated by craniotomyX- Must not drive and must notify the DVLA.

Driving may resume after 6 months if there is no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply if there is a history of seizure.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Relicensing may be considered 10 years after surgical obliteration of the lesion.

The epilepsy regulations (see Appendix B) apply.
Treated by radiosurgery (whether cavernous malformation incidental or symptomatic)! - May drive and need not notify the DVLA.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.
! - May drive and need not notify the DVLA.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.

Infratentorial cavernous malformation

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Incidental finding√- May drive and need not notify the DVLA.√- May drive and need not notify the DVLA.
With haemorrhage and/or focal neurological deficit, no surgical treatment!- May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.
! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.
Treated by craniotomy! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.
! - May drive and need not notify the DVLA.

There must be no debarring residual impairment likely to affect safe driving.

The epilepsy regulations (see Appendix B) apply and the patient must not drive and must notify the DVLA if there is a history of seizure.

Intracerebal abscess/subdural empyema

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive but need not notify the DVLA.

Driving may resume after 1 year.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Given there is a very high prospective risk of seizure, it will be 10 years before relicensing may be considered and there must have been no seizures without treatment in that time.

Cranioplasty

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May drive but must notify the DVLA.

Driving may resume on recovery providing there are no complications. If these occur, the relevant licensing standards would apply. The underlying conditions leading to surgery will require consideration.
X- Must not drive and must notify the DVLA.

Relicensing may be considered after 6 to 12 months from treatment depending on individual features.

Hydrocephalus

Group 1
Car and motorcycle
Group 2
Bus and lorry
√- May drive and need not notify the DVLA.

If the hydrocephalus is uncomplicated, driving may continue under the 'till 70 licence.
X- Must not drive and must notify the DVLA.

Driving will be allowed to continue if the hydrocephalus is uncomplicated and there are no associated neurological problems.

Intraventricular shunt or extraventricular drain – insertion or revision of upper end of shunt or drain

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA. Driving may be relicensed after 6 months if there is no debarring residual impairment likely to affect safe driving.X- Must not drive and must notify the DVLA.

Neuroendoscopic procedures – third ventriculostomy, for example

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

Driving may be relicensed after 6 months if there is no debarring residual impairment likely to affect safe driving and no other disqualifying condition.
X- Must not drive and must notify the DVLA.

Driving may be relicensed after a minimum of 6 months depending on individual assessment of the underlying condition.

Intracranial pressure monitoring device – inserted by burr hole surgery

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

The prospective risk from the underlying condition must be considered.
X- Must not drive and must notify the DVLA.

The prospective risk from the underlying condition must be considered.

Implanted electrodes

Group 1
Car and motorcycle
Group 2
Bus and lorry
Deep brain stimulation for movement disorder or pain
! - Should not drive but need not notify the DVLA.

May drive if there are no complications from surgery and the patient is seizure-free, provided there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

Fitness to drive may be assessed for relicensing if there are no complications from surgery and the patient is seizure-free with an underlying condition that is nonprogressive, provided there is no debarring residual impairment likely to affect safe driving.
Implanted motor cortex stimulator for pain relief
X- Must not drive and must notify the DVLA. Driving may be relicensed after 6 months if the aetiology of the pain is non-cerebral – trigeminal neuralgia, for example.

If the aetiology is cerebral – stroke, for example – it will be 12 months before driving may be relicensed, provided there is no debarring residual impairment likely to affect safe driving.
X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

© Crown copyright. Reproduced under the terms of the Open Government Licence.

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Author:
DVLA
Peer Reviewer:
DVLA
Document ID:
13175 (v10)
Last Checked:
07 March 2017

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.