Physical Qualification Standards and Advisory Criteria - Neurological

Question 1

Waiting period for anticoagulant therapy

Answer 1

1 month stabilized INR

Must provide a copy of INR results and have at least monthly monitoring

Question 2

Max certification period for a patient on anticoagulants

Answer 2

1 year

Question 3

Recommend not to certify a driver on anticoagulants if…

Answer 3

The driver has an underlying cerebrovascular disorder

Question 4

Can you certify a driver who is on anticonvulsant therapy?

Answer 4

Only if nature and severity of the underlying condition does not interfere with safe driving and effects of medication used while operating a CMV does not endanger the driver or the public

Question 5

When should you disqualify a driver on anticonvulsants?

Answer 5

If the anticonvulsant meds are used to control or prevent seizures

Question 6

The risk for subsequent unprovoked seizures is greatest when?

Answer 6

In the first 2 years following an acute brain insult

Question 7

For the entire waiting period following seizure, the driver should be…

Answer 7

Seizure free

Off anticonvulsant meds for the control of seizures

Question 8

When should you apply a 1 year waiting period for seizures?

Answer 8

Mild insult w/o early seizures
Stroke w/o risk for seizures
Intracerebral or subarachnoid hemorrhage w/o risk for seizures

Must be seizure free and off anticonvulsants for the entire 1 year waiting period

Question 9

When should you apply a 2 year waiting period for seizures?

Answer 9

Moderate insult w/o early seizures
Mild insult with early seizures

Must be seizure free and off anticonvulsants for the entire 2 year waiting period

Question 10

When should you apply a 5 year waiting period for seizures?

Answer 10

Moderate insult with early seizures
Stroke with risk for seizures
Intracerebral or subarachnoid hemorrhage with risk for seizures

Must be seizure free and off anticonvulsants for the entire 5 year waiting period

Question 11

How long can a driver with history of seizures be certified for?

Answer 11

1 year, if:

Driver with a hx of mild or moderate insult who has:

• Completed the min waiting period seizure free and off meds
• Normal PE, neuro exam, and neuropsycho test
• Clearance from a neurologist

Question 12

For seizures caused by metabolic dysfunction, is there a specific waiting period?

Answer 12

No. Can certify for up to 2 years provided the underlying systemic metabolic dysfunction has been corrected and driver has no disqualifying risk or recurrence

Question 13

Can a driver with childhood seizures be certified?

Answer 13

Yes, for up to 2 years, provided seizures were limited to childhood febrile seizures

Question 14

Following an unprovoked seizure, the driver should be seizure free and off anticonvulsants for at least _____ to distinguish between a medical history of a single seizure and epilepsy.

Answer 14

5 years

Question 15

If a driver has a second seizure following an unprovoked seizure, regardless of the elapsed time…

Answer 15

That would constitute a medical history of epilepsy and driver would no longer be eligible for certification.

Question 16

Waiting period for drivers with history of unprovoked seizure

Answer 16

10 years off anticonvulsants and seizure free provided they have no established medical history or diagnosis of epilepsy

Question 17

Recommend to certify a driver with a single unprovoked seizure if …

Answer 17

Completed the minimum 5 year waiting period seizure free and off anticonvulsants

Clearance by neurologist

Question 18

Can a driver with vertigo be certified?

Answer 18

Yes, with 2 mo waiting period asymptomatic with dx of BPPV or acute or chronic peripheral vestibulopathy

Question 19

Do not certify a driver for dizziness/vertigo if the driver has a diagnosis of…

Answer 19

BPPV with symptoms in the last 2 mo
Acute/chronic peripheral vestibulopathy with symptoms in the last 2 mo
Meniere's disease
Labyrinthine fistula
Nonfunctioning labyrinths

Question 20

When can you apply a 1 year waiting period for CNS infections?

Answer 20

1 year seizure free and off anticonvulsants for:

Bacterial meningitis w/o early seizures
Viral encephalitis w/o early seizures

Question 21

When can you apply a 5 year waiting period for CNS infections?

Answer 21

5 years seizure free and off anticonvulsants for

Bacterial meningitis with early seizures

Question 22

When can you apply a 10 year waiting period for CNS infections?

Answer 22

10 years seizure free and off anticonvulsant meds for

Viral encephalitis with early seizures

Question 23

Does a driver with a history of aseptic meningitis require a waiting period?

Answer 23

No

Question 24

Do not certify a driver with autonomic neuropathy who has…

Answer 24

Cardiovascular autonomic neuropathy causing resting tachycardia or orthostatic BP

Other organ autonomic neuropathy that interferes with driving ability

Question 25

For drivers with abnormal muscle activity, do not certify a driver who has a diagnosis of...

Answer 25

Myotonia Isaac's Syndrom Stiff-man syndrome

Question 26

Can a driver with a congenital myopathy be certified?

Answer 26

No These include central core disease, centronuclear myopathy, congenital muscular dystrophy, rod (nemaline) myopathy

Question 27

Can a driver with a metabolic muscle disease be certified?

Answer 27

Nope

Question 28

Can a driver with a motor neuron disease be certified?

Answer 28

Nope

Question 29

How about muscular dystrophy? Can a driver with that be certified

Answer 29

NOPE

Question 30

Neuromuscular junction disease (ie myasthenia gravis)

Answer 30

They can't drive either. It's a damn shame.

Question 31

Peripheral neuropathy?

Answer 31

They can't drive either

Question 32

What type of CNS tumors need a 1 year waiting period?

Answer 32

``` 1 year post surgical removal of... Intratentorial meningiomas Acoustic neuromas Pituitary adenomas Spinal benign tumors Benign extra-axial tumors ```

Question 33

What type of CNS tumors need a 2 year waiting period?

Answer 33

2 years post surgical removal of... Benign supratentorial tumors Spinal tumors

Question 34

Max certification period for a driver with a CNS tumor?

Answer 34

1 year certification following 1 or 2 year waiting period after removal Has to have stable nonprogressive deficit or no neuro deficit Imaging must show no tumors

Question 35

Can a driver with dementia be certified?

Answer 35

Hell no

Question 36

Waiting period for embolic and thrombotic strokes

Answer 36

1 year if not at risk for seizures (cerebellum or brainstem vascular lesions) 5 years if at risk for seizures (cortical or subcortical deficits)

Question 37

Max certification for embolic/thrombotic strokes

Answer 37

1 year, provided: - Waiting period complete - Normal PE, neuro exam including neuro-ophthalmological eval and neuropsych testing - No neuro residuals, or if present severity that doesn't interfere with driving - Clearance by a neurologist

Question 38

Waiting period following intracerebral and subarachnoid hemorrhages

Answer 38

1 year if not at risk for seizures 5 years if at risk for seizures

Question 39

Max certification following intracerebral and subarachnoid hemorrhages

Answer 39

1 year, same requires as for embolic/thrombotic strokes

Question 40

How about waiting period for TIAs?

Answer 40

Same as the other types of stroke: 1 year if not at risk for seizures 5 years if at risk for seizures

Question 41

Max certification after TIAs

Answer 41

1 year

Question 42

What is the best predictor of future risk of seizures following TBI?

Answer 42

The length of time an individual is seizure free and off anticonvulsant meds

Question 43

A waiting period of 2 years seizure free and off anticonvulsants is appropriate for what type of TBIs?

Answer 43

Moderate TBI w/o early seizures Mild TBI with early seizures

Question 44

A waiting period of 5 years seizure free and off anticonvulsants is appropriate for what type of TBIs?

Answer 44

Moderate TBI with early seizures

Question 45

Max certification following TBI

Answer 45

1 year, unless it was a mild TBI without early seizures (that gets 2 years)

Question 46

See page 166 for a great table

Answer 46

What did I just say?!