Driving and Neurological Disease Summary

Seizures and Epilepsy

Resumption of unconditional licence

Requirement for review/medical certification

Blackout and syncope

Vision

Stroke

Other neurological/neurosurgical conditions

Private and commercial definition

* Please note this is summary only – make sure you are familiar with the full text of

the Austroads guidelines before giving any advice *

* The responsibility for licencing decisions lies with the Queensland department transport and

main roads*

Seizures and Epilepsy

From the 2022 Guidelines:

	Private licence (see definition)	Commercial licence (see definition)
Default after any seizure	12 months AND The person follows medical advice, including adherence to medication if prescribed or recommended.	*10 years AND normal EEG** (* No epileptic abnormalities) AND The person follows medical advice, including adherence to medication if prescribed or recommended.
Reduction from the default timeframes may be considered if patients fit into one of the following categories:
First seizure	6 months	5 years AND An EEG must be done within the 6 months before return to driving and show no epileptic abnormalities AND No other abnormal EEGs in last 12 months
Acute symptomatic seizure* * seizures are caused by a transient brain disorder or metabolic disturbance AND occur during the disturbance. e.g. head injury, encephalitis, drug withdrawal	6 months (12 months if two separate transient disorders have occurred e.g. if two separate episodes of drug withdrawal seizure occur)	12 months AND An EEG must be done within the 6 months before return to driving and show no epileptic abnormalities AND No other abnormal EEGs in last 12 months
Epilepsy
- Treated for the first time	No seizures in last 6 months AND At least 6 months of treatment AND If any seizures since starting treatment they occurred in first 6 months i.e. If any seizures occur in the first 6 months after starting treatment a 6 month restriction can restart. If a seizure occurs at any time after the first 6 months of treatment the default 12 months applies.	No reduction
- Previously well controlled epilepsy (i.e. no seizures for 12 months)	3 months if no provoking factor 4 weeks (if clear provoking factor which has not caused previous seizures. Sleep deprivation does not count)	No reduction
- Sleep seizures - only ever in sleep	Can continue to drive despite seizures as long as it has been 12 months since first sleep seizure.	No reduction
- Sleep seizures - Previous awake seizures but now only sleep seizures	2 years (since last awake seizure) AND sleep only seizures have been occurring for at least 2 years	No reduction
- ‘Safe’ seizures - (i.e. awareness and control maintained)	Safe seizures present >2 years AND No other/unsafe seizures in previous 2 years	No reduction
Medication withdrawal or reduction (Including switch in anti-seizure medication)	During reduction and then 3 months (May not apply if reduction due to dose related side effects or after temporary increased dose)	No reduction
- Seizure during withdrawal/change and previous effective medication restarted	4 weeks once full dose of previously effective medication restarted	No reduction
Post surgery for epilepsy	12 months	*10 years and normal EEG (and continuing medication)** (* No epileptic abnormalities)
If seizure causes MVA (or loss of control of vehicle)	12 months – no reductions allowed	10 years – no reductions allowed
Psychogenic Non-epileptic seizures * * Psychiatry section of guidelines	There have been no further psychogenic seizures for at least 3 months OR – If Active PNES: The situational context or the semiology has been stable for at least 12 months AND the psychogenic seizures - have not caused a loss of awareness or responsiveness; AND - have not resulted in injury; AND - would not disrupt the driving task OR Could not occur when a person is driving; AND Only occur in response to triggers that will not be encountered whilst driving.	There have been no further psychogenic seizures for at least 3 months

Resumption of unconditional licence

	Private	Commercial
Default	No seizures for 5 years No anti-seizure medication for last 12 months	Remain on conditional licence
First seizure AND Acute symptomatic seizures	There have been no seizures for at least 2 years. AND Antiseizure medication has not been prescribed in the past 12 months	There have been no seizures for at least 10 years; AND Antiseizure medication has not been prescribed in the past 12 months; AND EEG conducted in the last 6 months has shown no epileptiform activity and no other EEG conducted in the last 12 months has shown epileptiform activity.
Childhood epilepsy syndrome	If the patient had a benign childhood epilepsy and no seizures after the age of 11 then they can hold an unconditional licence	If the patient had a benign childhood epilepsy and no seizures after the age of 11 then they can hold an unconditional licence

Requirement for review/medical certification

	Private	Commercial
Default	Annual	Annual
Prolonged seizure freedom	If seizure free for 10 years can consider prolonging review period up to every 3 years.	If seizure free for 20 years can consider prolonging review period up to every 3 years.

Blackout and syncope

- Syncope

If vasovagal, situational and unlikely to occur while driving – No restriction

After other causes of syncope can resume driving after 4 weeks IF cause has been identified and treated and symptoms resolved.

5 Years

- Unknown cause

6 months – for single event (or several within 24hours)

12 months – if >1 episode

10 Years

- Hypoglycaemia*

* See endocrinology section in guidelines

Minimum 6 weeks (and requires endocrinology assessment/approval of ongoing control and symptom awareness)

Vision

**If standard visual acuity and visual field criteria not met then specialised optometry/ophthalmology assessment required**

	Private vehicle	Commercial
Visual acuity	Unconditional licence: - Uncorrected VA at least 6/12 in best eye (or with both eyes) Conditional licence: - If VA criteria met with corrective lens	Unconditional licence: - Uncorrected VA at least 6/9 in best eye - AND VA at least 6/18 in worse eye Conditional licence: - If VA criteria met with corrective lens
Visual fields	Binocular visual field (with fixation) at least 110 degrees within 10 degrees above and below the horizontal midline - From last seen spot to last seen spot - A scotoma of up to three adjacent spots can be ignored AND No scotoma within the central 20 degrees of foveal fixation - 4 or more adjacent missed spots - 3 adjacent missed spots AND any other missed spot in central 20deg - Any missed spots in central 20deg that are a extension of a hemianopia or quadrantanopia of 3 or more spots	Binocular visual field at least 140 degrees within 10 degrees above and below the horizontal midline AND No scotoma likely to affect driving
Monocular visual loss	3 months after visual loss (until adaptation to monocular vision has occurred)	Does not meet criteria
Diplopia	No diplopia within central 20 degrees of primary gaze (exception can be given)	No diplopia within central 20 degrees of primary gaze

Stroke

	Private vehicle	Commercial
TIA (“Advisory only”)	2 weeks	4 weeks minimum
Stroke	4 weeks minimum (depending on deficit) Conditional licence not required unless persisting deficits likely to affect driving task	3 months minimum (depending on deficit) Conditional licence required for all
SAH	3 months minimum (depending on deficit) Requires conditional licence for all expect minor convexity SAH.	6 months minimum (depending on deficit) Requires conditional licence for all expect minor convexity SAH.
Aneurysm – see below

Other neurological/neurosurgical conditions

	Private vehicle	Commercial
Aneurysm	If high risk of symptomatic haemorrhage – cannot drive until treated.
Head Injury	Dependent on nature of injury or deficit
Intracranial surgery	6 months	12 months
Space occupying lesions (inc. Brain tumours)	Case by case basis - Often difficult – depends on functional impairment as well as risk of lesion growth and risk of seizure
Substance abuse (e.g. heavy, frequent alcohol use/dependence)	Must be in a treatment program and in remission for at least 1 month.
Peripheral neuropathy	Case by case basis
Dementia	Case by case basis (Requires conditional licence)
Parkinson’s Disease	Case by case basis Conditional licence required if significant impairment or dementia	Case by case basis Conditional licence for all

Private and commercial definition

Private standard

• Applies to:

o Car (up to 12 passengers)

o Motorcycle

o Light rigid (LR) (GVM 4.5 to 8 tonnes (plus trailer <9tonnes GVM: Small truck, Large Van, small bus)

Commercial standard

• Applies to:

o Medium rigid (MR)

o Heavy rigid (HR)

o Heavy combination (HC)

o Multiple combinations (MC)

o Drivers carrying public passengers for hire or reward (Bus, taxi (including Uber etc.), mini-bus)

o Drivers carrying bulk dangerous goods