What to do after a Seizure, Stroke, or TIA (mini stroke). A clarification.
By Dr. Alexander E. Underwood
There is quite a bit of misinformation in the commercial driving industry about driving after a stroke, ministroke (TIA) or seizure. This issue is so complex that many medical examiners (CME’s) will have to reach out to FMCSA for guidance on certifying drivers. The most important and pressing issue when it comes to certifying a driver medically is: will this driver, in the future have a sudden loss of consciousness or sudden loss of ability to control a motor vehicle. Naturally, the aforementioned neurological issues are of serious importance because they are among the most likely issues to cause a dangerous and sudden impairment of a driver. These have in the past caused traffic fatalities for commercial drivers and the motoring public alike. Thankfully, DOT has agreed with medical advisory boards that not all neurological conditions preclude a driver from a safe and successful driving career.
Much like hypertension and Diabetes, a stroke or mini stroke, medically known as a transient ischemic attack (TIA) occur more frequently in commercial drivers than the general population. Diabetes and hypertension also have a significant contributory factor to development of TIAs and strokes. In the majority of cases, If you have suffered a stroke or TIA, you will eventually be able to resume your driving career. If you are left with permanent residual effects that leave you disabled, you will not be certifiable as commercial driver. After initially recovering from a stroke or TIA you will be forced to wait at least an entire year before being eligible for a DOT medical certificate. If you have a more severe stroke or brain bleed that involves middle cerebral or anterior cerebral artery, guidelines suggest you wait 5 years before returning. Before returning for your DOT medical exam, you will need clearance from your neurologist, supporting medical paperwork, must be seizure and anticonvulsant free and may be asked to complete an on-road driving evaluation comparable to those done for new drivers. If you pass all the other requirements of a DOT medical exam, you will be certified for a maximum of 1 year at a time.
A seizure is possibly the most dangerous medical emergency a driver can have on the road. Accordingly, the DOT and FMCSA take seizures and seizure disorder very seriously. Previously, any driver with a seizure disorder currently taking anti seizure medication was automatically medically disqualified. As of recently, the FMCSA has granted a federal waiver for those with seizure disorders taking long term antiseizure medication. In order to qualify for a federal exemption a driver MUST be seizure free off or on medication for 8 years. If not on medication, the previous 8 years must be seizure free. If currently taking medication, the driver must be on the same stable medication regimen for at least 2 years. Further, a driver may be qualified (without a waiver) with a history of epilepsy if seizure free and medication free for 10 years.
Many seizures are not the result of a seizure disorder like epilepsy. If you have a single a sudden episode of a nonepileptic seizure or loss of consciousness of unknown cause which did not require antiseizure medication the rules are much less stringent. The decision to certify a driver will ultimately be left up to the individual examiner(CME). A waiting period of at least six months since the incident is advised. If there are no further seizures, no antiseizure medication required and clearance is provided by a neurologist, the driver may be qualified. If the driver suffers from a single seizure by a known cause ie (high fever, drug reaction, infection, etc), the driver may be certified if there are no residual symptoms, neurology clearance is provided, with no specific waiting period.