Episodic Neurological Conditions Flashcards
(41 cards)
define an episodic neurologic condition.
The condition occurs periodically and/or repeatedly, but not continuously.
Name examples of episodic neurologic conditions.
-Headaches
-dizziness and vertigo
-epilepsy/seizures
Can drivers with chronic headaches be certified?
-Sometimes, but not always
-must thoroughly examine degree, intensity, and duration of the headaches; it may be severe enough to prevent certification
-must also consider side effects of medications used to prevent or control headache pain, and disqualify patient if these medicines interfere with safe driving
-also consider whether the main effects of treatments interfere with safe driving
-disqualify for associated symptoms that may lead to unsafe driving, such as visual disturbances or severe mood swings
Name some medicines are commonly used to treat headaches which would disqualify a patient from driving for as long as a using these medications.
Benzodiazepines and other sedatives
Barbiturates (e.g. phenobarbital, Barbital)
Codeine
Propoxyphene
analgesics that combine sedatives antihistamines
narcotics
phenothiazines such as chlorpromazine or promethazine
decongestants are not disqualifying.
Antihistamine usage is evaluated on a case-by-case basis; antihistamine use is not immediately disqualifying.
When must you deny certification to a pt with chronic headaches?
Do not certify until and unless the following conditions are met:
-etiology is confirmed
-treatment is shown to be safe and effective
-nature and severity do not interfere with safe driving
If a patient has chronic headaches is certified, what is the maximum duration of time for which they can be certified?
-Certification is for maximum of two years
-obtain additional tests when indicated
-must have medical exam at least once every two years
Can patients with dizziness and vertigo be certified? What are dizziness and vertigo?
Dizziness = lightheadedness, swaying, floating, spinning
Vertigo = feeling of movement when no actual movement is present
Qualify or disqualify based on:
-meds used for treatment
-severity of individual symptoms; driver might need specialty evaluation
Which medications used for treating dizziness and vertigo would disqualify patient from certification?
Benzodiazepines and phenothiazines are disqualifying.
use of antihistamines requires evaluation side effects
Suppose a driver is diagnosed with benign positional vertigo or acute or chronic peripheral vestibulopathy. Under what circumstances can you certify this driver?
all the following criteria must be met:
-Patient is asymptomatic two months after diagnosis
-nature and severity don’t interfere with safe driving
-treatment is safe and effective
Remember: benzodiazepines and phenothiazines are disqualifying; antihistamines require evaluation for side effects
Suppose a driver suffers from vertigo or dizziness. Under what circumstances are you unable to certify this driver?
-Symptomatic within the previous two months after being diagnosed with benign positional vertigo or acute or chronic peripheral vestibulopathy
-nature and severity of the diagnosis interfere with safe driving
-driver has been diagnosed with Ménière’s disease, labyrinthine fistula, and or nonfunctioning labyrinths
-use of benzodiazepines or phenothiazines
If a driver with dizziness or vertigo is certified, was the maximum certification period you can give?
Certify for maximum of two years; if driver requires special evaluation or screening, then only certify for one year
Driver must be examined at least once every two years
What factors affect risk for future seizures in a pt who has epilepsy?
-length of time sz free and off anticonvulsants
-underlying cause of szs
-area of brain affected
Define the term seizure.
Clinical manifestation of an abnormal electrical discharge involving a set of cortical neurons.
Can a person who sustained a single, unprovoked seizure be certified?
Yes
-reqs person to be sz free and off anticonvulsants for five years
-person also needs clearance from a neurologist
-certify for a maximum of one year
-must have a medical exam at least once every two yrs
Is a provoked seizure disqualifying?
No.
A provoked seizure results from a specific cause, such as anesthesia induced seizures, febrile seizures, systemic metabolic illness, seizure due to hypoglycemia, medication side effects, etc.
Under what circumstances can a driver who has a history of seizures limited to childhood febrile seizures be certified?
These drivers can almost always be certified. The general rule about withholding certification if the nature and severity pose a risk to safety really does apply here, because children don’t drive big trucks.
What is the maximum certification period for a driver who reports a history of seizures limited to childhood febrile seizures, or who suffered a provoked seizure due to an identified cause?
Certify for maximum of two years
-additional testing can be done on a case-by-case basis we needed
-driver must have a biennial medical exam
Suppose the driver has a seizure due to structural insult to the brain. During what time period is the driver at highest risk for having another seizure?
Greatest risk of seizure is in the first two years after the insult
For a driver who has been accused seizure due to structural insult to the brain, what factors affect likelihood of recurrence of seizure?
-Location and severity of the insult
-timing of first seizure after the insult, except with occlusive vascular insults
Best predictor for seizures is the time driver he seizure free and off anticonvulsants.
Embolic and thrombotic cerebral infarctions are the most common forms of cardiovascular disease. Risk for complicating seizures is associated with the ______________________.
location of the lesions
- Cerebellum and brainstem vascular lesions are not associated with an increased risk for seizures.
- Cortical and subcortical deficits are associated with an increased risk for seizures.
- Evaluation by a neurologist is necessary to confirm the area of involvement.
Drivers with embolic or thrombotic cerebral infarctions will have residual intellectual or physical impairments. Fatigue, prolonged work, and stress may exaggerate the neurological residuals from a stroke. Most recovery from a stroke will occur within _______ of the event.
1 year
If a driver has suffered an embolic or thrombotic stroke, what is the minimum waiting period before they can be considered for certification?
Minimum — 1 year if not at risk for seizures (cerebellum or brainstem vascular lesions)
Minimum — 5 years if at risk for seizures (cortical or subcortical deficits)
What is the maximum certification period you can give to a driver who has had an embolic or thrombotic cerebral infarction?
Maximum certification — 1 year
Recommend to certify if: The driver with a history of stroke has:
* Completed the appropriate waiting period.
* Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological testing.
* No neurological residuals or, if present, residuals of a severity that does not interfere with ability to operate a commercial motor vehicle.
* Clearance from a neurologist who understands the functions and demands of commercial driving.
The driver should have an annual medical examination.
When is it recommended to not certify the driver who has sustained an embolic or thrombotic stroke?
Recommend not to certify if:
The driver:
* Has not completed the appropriate waiting period.
* Uses oral anticoagulant therapy because of the risks associated with excessive bleeding.
* Uses any other drug or combination of drugs that have potentially high rates of complications (e.g., depressing effects on the nervous system).
* Has residual intellectual or physical impairments that interfere with commercial driving.
* Does not have clearance from a neurologist who understands the functions and demands of commercial driving
