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Reflex vasovagal syncope?
group 1 and 2 - no restrictions
no need to inform DVLA
Loss of conciousness/loss of or altered awareness likely to be unexplained syncope but with a high probability of reflex vasovagal syncope?
No clinical evidence of structural heart disease and normal ECG
group 1- no driving restrictions, DVLA need not be informed
group 2- can drive only 3 months after event
Loss of conciousness/loss of or altered awareness likely to be cardiovascular in origin
factors ind high risk- abnormal ecg, clinical evidence structural heart disease, syncope causing injury occuring at the wheel or whilst sitting or lying, more than one episode in preceding 6m
group 1- license refused/revoked for 6m if no cause found, can drive after four weeks if cause identified and treated.
group 2-license refuse/revoked for 12m if no cause identified, can drive after 3m if cause identified and treated
presumed loss of conciousness with seizure markers?
factors to consider: tongue biting, unconcious greater than 5mins,injury, incontinence.
group 1- 6months off driving if prev epilepsy history then 12m
group 2- 5 years seizure free before driving is ok
LOC with no clinical pointers? no abnormality detected on investigations
group 1- license revoked 6m
group 2- licence revoked for one year
primary/central hypersomnias: eg. narcolepsy?
group 1-cease driving on diagnosis, resume after 3-6m stable on treatment and osler test ok
group 2- cease driving on diagnosis, may be allowed to drive after specialist assessment and satisfactor osler test for wakefulness
chronic neuro disorders- ms, motor neurone- may affect vehicle control due to coordination/muscle power
group 1- medical assessment to ensure driving control not impaired, given a 1,2 or 3yr license then r/v
group 2-license refused/revoked if condition is progressive or disabling. If driving would not be impaired and condition stable,can be considered for licensing subject to satisfactory reports and annual reviews.
liability to sudden attacks of unprovoked diasbling giddiness?
group 1- cease driving on diagnosis,permitted when satisfactory control of symptoms.
group 2-license refused/revoked if condition is disabling, if likely to cause recurrent attacks must be symptom free and free from attack for one year
- group 1 - TIA-no need to notify DVLA
- stroke-cease driving for one month as long as no neurological deficit after this time
group2-license refused/revoked for one year after stroke/tia then ok as above but need ECG exercise testing
craniotomy and/or endoscopic treatment
- group 1- 6m off
- group 2- can drive after two years
malignant cranial tumours
group 1 - depends on type range 1-2 yrs
group 2- permanent refusal or revocation
group 1- person who has had a seizure whilst awake must be seizure free for one year, if seizure whilst asleep same applies except if had another sleep attack more than three years previously in which case they remain licensed
group 2- need to stay seizure free for ten years without meds
group 1- cease driving when symptoms occur at rest,with emotion or at the wheel, dvla no need to tell them
group 2- refusal/revocation with continuing symptoms, relicensing when free for 6/52, exercise tests met
ACS defined as:
-NSTEMI with 2 of: symptoms at rest, raised troponin, ECG changes
- STEMI symptoms with ST elevation
- group 1- if successfully treated by coronary angioplasty driving can start after one week provided: no other urgent revascularisation planned, no other disqualifying cond, LVEF is at least 40% prior to discharge.
- If no angioplasty must stop driving 4 weeks
group 2- 6/52 stop driving, relicensing aftersatisfactory investigations
group 1- 1/52
group 2- 6/52
group 1- 4/52
group 2- 3/12
group 1- cease driving if the arrythmia will cause incapacity. If cause identified and controlled can drive after 4 weeks
group 2- disqualifies if causes incapacity.Ok if controlled for 3/12, LVEF above 40%
successful catheter ablation?
group 1- 2/7
group 2- 6/52
group 1- 1/52
group 2 - 6/52
group 1- notify DVLA any aneurysm of 6cm, annual licensing above 6.5cm disqualifies
group 2- disqualifies if greater than 5.5cm diameter
disqualifies group 2 if resting BP above 180mmhg systolic or 100mmhg diastolic