17 - Seizures and epilepsy - CCMTA Medical Standards

Last updated on January 25, 2021

Seizures, epilepsy and medical fitness to drive.

17.6.1 Provoked seizures caused by a structural brain abnormality
17.6.2 Provoked seizures with no structural brain abnormality
17.6.3 Alcohol-withdrawal seizures
17.6.4 Single unprovoked seizure – Non-commercial drivers
17.6.5 Single unprovoked seizure – Commercial drivers
17.6.6 Epilepsy – Non-commercial drivers
17.6.7 Epilepsy with seizures only while asleep or upon awakening – Non-commercial drivers
17.6.8 Epilepsy with simple partial seizures – Non-commercial drivers
17.6.9 Surgery for epilepsy – Non-commercial drivers
17.6.10 Surgery for epilepsy – Commercial drivers
17.6.11 Epilepsy with medication change – Non-commercial drivers
17.6.12 Epilepsy – Commercial drivers
17.6.13 Epilepsy with seizures only while asleep or upon awakening – Commercial drivers
17.6.14 Epilepsy with simple partial seizures – Commercial drivers
17.6.15 Epilepsy with medication change – Commercial drivers

17.1 About seizures and epilepsy

Seizures

A seizure is caused by a sudden electrical discharge in the brain. A seizure does not always mean that a person falls to the ground in convulsions. It can be manifested in various ways, including:

Feelings of being absent
Visual distortions
Nausea
Vertigo
Tingling
Twitching
Shaking
Rigidity of parts of the body or the entire body, or
An alteration or loss of consciousness

Seizures may occur in people who do not have epilepsy. These non-epileptic seizures are often referred to as provoked seizures. Some are caused by transient factors with no structural brain abnormality such as:

Fever
Low blood sugar
Electrolyte imbalance
Head trauma
Meningitis
Simple fainting, and
Alcohol or drug toxicity or withdrawal

Others are caused by conditions where there is a structural brain abnormality such as a:

Tumour
Stroke
Aneurysm, or
Hematoma

Provoked seizures are not epilepsy, and they resolve after the provoking factor has resolved or stabilized.

Sometimes people appear to have seizures, even though their brains show no seizure activity. This phenomenon is called a non-epileptic psychogenic seizure (NEPS), sometimes referred to as a pseudoseizure, and is psychological in origin. Some people with epilepsy have NEPS in addition to their epileptic seizures. Other people who have NEPS do not have epilepsy at all.

Epilepsy

Epilepsy refers to a condition characterized by recurrent (at least two) seizures, which do not have a transient provoking cause. The cause of the epileptic seizures may be known or unknown (idiopathic). About two-thirds of epilepsy in young adults is idiopathic, but more than half of epilepsy in those 65 and older has a known cause. Known causes of epilepsy include permanent structural brain abnormality such as scarring from:

Stroke
Prior surgery
Head injury
Infections
Tumours
Aneurysms, or
Arteriovenous malformations.

Types of seizures

Seizures are divided into two main categories: partial (also called focal or local) seizures and generalized seizures. A partial seizure is a seizure that arises from an electrical discharge in one part of the brain. A generalized seizure is caused by discharges throughout the brain.

Partial seizures

There are three types of partial seizures:

Simple partial seizures
Complex partial seizures, and
Partial seizures (simple or complex) that evolve into secondary generalized seizures (see below).

The difference between simple and complex seizures is that individuals experiencing simple partial seizures retain awareness during the seizure, whereas those experiencing complex partial seizures lose awareness during the seizure.

Symptoms of partial seizures depend on which part of the brain is affected. They may include one or more of the following:

Head turning
Eye movements
Mouth movements
Lip smacking
Drooling
Apparently purposeful movements
Rhythmic muscle contractions in a part of the body
Abnormal numbness
Tingling and a crawling sensation over the skin
Sensory disturbances such as smelling or hearing things that are not there, or
Having a sudden flood of emotions.

Individuals who have partial seizures, especially complex partial seizures, may experience an aura, i.e. unusual sensations that warn of an impending seizure. An aura is actually a simple partial seizure. The aura symptoms an individual experiences and the progression of those symptoms tend to be similar every time.

Generalized seizures

Types of generalized seizures and their symptoms are listed in the table below.

Type of Generalized Seizure	Symptoms
Absence	Brief loss of consciousness
Myoclonic	Sporadic (isolated), jerking movements
Clonic	Repetitive, jerking movements
Tonic	Muscle stiffness, rigidity
Tonic-clonic or ‘grand mal’	Unconsciousness, convulsions, muscle rigidity
Atonic	Loss of muscle tone

Most common seizures

The three most common types of seizures in adults are:

Generalized tonic-clonic or grand mal seizures
Complex partial seizures, and
Simple partial seizures

Approximately one-third of all individuals with epilepsy have complex partial seizures, with the prevalence increasing to one-half in those with epilepsy who are 65 and older.

Recurrence of seizures

The estimated risk of a recurrence after an initial unprovoked seizure ranges from 23% to 71%, with the average risk of recurrence for adults being 43%. If the seizure is idiopathic (i.e. the cause is unknown) and the individual’s electroencephalogram (EEG) is normal, the risk of recurrence is reduced. Individuals who experience a partial seizure and have an abnormal EEG or other neurological abnormality, have an increased risk for seizure recurrence. A family history of epilepsy also increases the risk of recurrence.

Treatment for seizures and epilepsy

Seizure patterns in individuals with epilepsy may change over time, and seizures may eventually stop. Epilepsy is generally treated with anticonvulsant drugs (antiepileptics) and is sometimes treated with surgery to remove the source of epilepsy from the brain. Recent studies indicate that more than half of newly diagnosed individuals with epilepsy can achieve seizure control with antiepileptic drugs. Many of those who achieve seizure control are eventually able to stop taking antiepileptic drugs and remain seizure-free.

However, the relapse rate with drug withdrawal is at least 30% to 40%. For a further discussion of the impact of antiepileptics on driving, see Chapter 15, Drugs, Alcohol and Driving.

17.2 Prevalence

Research indicates that up to 9% of the general population will have at least one seizure. Epilepsy has an overall prevalence rate of 0.6% in Canada, with an estimated incidence of 15,500 new cases per year (2003). The table below shows the prevalence of epilepsy in Canada by age*.

(*Source: Data from Ontario Health Survey, Community Health Survey and National Population Health Survey (Wiebe S, Bellhouse D, Fallary C, Eliasziv M. Burden of epilepsy: the Ontario health survey. Can J Neurol Sci 1999;26:263-70).)

Age (years)	Prevalence (%)	Age (years)	Prevalence (%)
0 – 11	0.3	25 – 44	0.7
12 – 14	0.6	46 – 64	0.7
16 – 24	0.6	> 65	0.7

17.3 Seizures, epilepsy and adverse driving outcomes

Research indicates that, in general, individuals with epilepsy have an increased risk for adverse driving outcomes. Variability in the methodology and study results makes it difficult to determine the extent of the increased risk.

Studies of crash rates indicate that the following factors increase the risk of crash for those with epilepsy:

Age – younger drivers have increased risk, particularly those under 25
Marital status – unmarried drivers are at a greater risk than married drivers, and
Treatment – those not receiving antiepileptic drug treatment are at greater risk than those receiving treatment.

17.4 Effect on functional ability to drive

Condition	Type of driving impairment and assessment approach	Primary functional ability affected	Assessment tools
Seizures Epilepsy	Episodic impairment: Medical assessment – likelihood of impairment	Variable – sudden impairment	Medical assessments

The primary consideration for drivers with epilepsy is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving.

17.5 Compensation

As seizures and epilepsy cause an episodic impairment of the functions necessary for driving, a driver cannot compensate.

17.6 Guideline for assessment

Rationale for all epilepsy and seizure standards

The general approach of the guideline for drivers with epilepsy or who experience seizures is that seizures must be controlled as a prerequisite to driving.

Most of the guidelines include a requirement for a seizure-free period. The purpose of this requirement for a provoked seizure is to establish the likelihood that the provoking factor has been successfully treated or stabilized. For an unprovoked seizure, the purpose is to allow time to assess the cause, and where epilepsy is diagnosed, to establish the likelihood that:

A therapeutic drug level has been achieved and maintained
The drug being used will prevent further seizures, and
There are no side effects that may affect the driver’s ability to drive safely.

The guidelines identify exceptions to the requirement to remain seizure free for non- commercial drivers who have epilepsy and who have only simple partial seizures, or seizures that only occur while they are asleep or immediately upon awakening.

17.6.1 Provoked seizures caused by a structural brain abnormality

This standard applies to drivers who have experienced provoked seizures caused by a structural brain abnormality such as:

A brain tumour
Stroke
Subdural hematoma, or
Aneurysm

National Standard	All drivers eligible for a licence if They have undergone a neurological assessment to determine the cause of the seizure, and epilepsy is not diagnosed It has been 6 months since the provoking factor stabilized, resolved, or was corrected, with or without treatment, and they have not had a seizure during that time The treating neurologist or neurosurgeon indicates that further seizures are unlikely
BC Guidelines	If further information is required, RoadSafetyBC may request A Driver’s Medical Examination Report Additional information from the treating physician, or A neurological assessment. The neurological assessment may be conducted by the treating physician, if the physician has treated the patient for two years or more. However, if a neurological assessment by the treating physician does not provide the required information, RoadSafetyBC may request an assessment from a neurologist
Conditions for maintaining licence	None
Reassessment	If the seizure occurred within the past 12 months, RoadSafetyBC will re-assess in one year If no further seizures are reported at that time, no further re-assessment, other than routine commercial or age-related re-assessment, is required
Information from health care providers	Date of the last seizure Description of the type of seizure Whether a neurological assessment has been conducted and the results of the assessment Date that the provoking factor stabilized, resolved or was corrected Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime Opinion of treating physician on whether further seizures are likely. Depending on the nature of the provoking factor, the opinion of a neurologist may be required to determine the risk of further seizures
Rationale	The primary consideration for drivers who experience seizures is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving. The purpose of a seizure-free period. requirement for a provoked seizure is to establish the likelihood that the provoking factor has been successfully treated or stabilized

17.6.2 Provoked seizure with no structural brain abnormality

This standard applies to drivers who have experienced provoked seizures caused by a:

Toxic illness
Adverse drug or alcohol reaction, and substance use disorder* is not diagnosed (*Note if substance use disorder is diagnosed, then 17.6.3 would apply)
Trauma, or
Other cause that is not associated with a structural brain abnormality (for example psycho genec non epileptic (PNES) .

National Standard	All drivers eligible for a licence if: They have undergone a neurological assessment to determine the cause of the seizure, and epilepsy is not diagnosed The provoking factor has stabilized, resolved, or been corrected, with or without treatment, and The treating physician indicates that further seizures are unlikely
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or A neurological assessment. The neurological assessment may be conducted by the treating physician, if the physician has treated the patient for two years or more. However, if a neurological assessment by the treating physician does not provide the required information, RoadSafetyBC may request an assessment from a neurologist
Conditions for maintaining licence	None
Reassessment	No re-assessment, other than routine commercial or age-related re-assessment, is required
Information from health care providers	Description of the type of seizure Whether a neurological assessment has been conducted and the results of the assessment Opinion of treating physician on whether the provoking factor has stabilized, resolved or been corrected Opinion of treating physician on whether further seizures are likely. Depending on the nature of the provoking factor, the opinion of a neurologist may be required to determine the risk of further seizures
Rationale	The primary consideration for drivers who experience seizures is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving. The general approach of the guidelines for drivers who experience seizures is that seizures must be controlled as a prerequisite to driving and/or the provoking factor has stabilized, resolved, or has been corrected

17.6.3 Alcohol withdrawal seizures

National Standard	All drivers eligible for a licence if: The treating physician has confirmed that the cause of the seizure was alcohol withdrawal (i.e. the driver is not epileptic) They have undergone addiction treatment and have received a favourable report from an addiction counsellor, The criteria for licence reinstatement are met in accordance with the Substance Use Disorder Standard (see 15.6.3)
BC Guidelines	If further information is required, RoadSafetyBC may request an assessment from a neurologist, a registered psychologist or an addictions specialist or a physician who is familiar with client’s past medical history or has access to client’s past clinical /medical records. For drivers without a diagnosis of alcohol use disorder, RoadSafetyBC may find individuals fit to drive if they meet the National Standard for 17.6.2. For drivers with a diagnosis of alcohol use disorder, RoadSafetyBC may find individuals fit to drive if they meet the above National Standard.
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must follow up regularly with your treating physician and comply with any prescribed treatment regime, and You must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Reassessment	RoadSafetyBC will re-assess in one year If no further seizures are reported at that time, no further re-assessment, other than routine commercial or age-related re-assessment, is required
Information from health care providers	Description of the cause of the seizure Date of the last seizure Details of treatment regime Date of abstinence Whether the driver has undergone addiction treatment Report from an addiction counsellor and / or treating physician whether the driver is compliant
Rationale	The primary consideration for drivers who experience seizures is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving. The purpose of a seizure-free period. requirement for a provoked seizure is to establish the likelihood that the provoking factor has been successfully treated or stabilized

17.6.4 Single unprovoked seizure – Non-commercial drivers

National Standard	Non-commercial drivers eligible for a licence if: Complete neurological assessment has been conducted to determine the cause of the seizure, and epilepsy is not diagnosed, and CNS imaging and EEG results are satisfactory
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or A neurological assessment. The neurological assessment may be conducted by the treating physician, if the physician has treated the patient for two years or more. However, if a neurological assessment by the treating physician does not provide the required information, RoadSafetyBC may request an assessment from a neurologist RoadSafetyBC may find individuals fit to drive if: If they meet standard above, and They have support from physician or neurologist to return to driving
Conditions for maintaining licence	None
Reassessment	If the seizure occurred within the past 12 months, RoadSafetyBC will re- assess in one year If no further seizures are reported at that time, no further re-assessment, other than routine age-related re-assessment, is required
Information from health care providers	Date of the seizure Description of the type of seizure Whether a neurological assessment has been conducted and the results of the assessment
Rationale	The primary consideration for drivers who experience seizures is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving.The purpose of a seizure-free period requirement for an unprovoked seizure is to allow time to assess the cause and establish seizures are controlled as a prerequisite to driving

17.6.5 Single unprovoked seizure – Commercial drivers

National Standard	Commercial drivers eligible for a licence if: It has been at least 12 months since the seizure occurred, and Complete neurological assessment has been conducted to determine the cause of the seizure, and epilepsy is not diagnosed, and CNS imaging and EEG results are satisfactory
BC Guidelines	If further information is required, RoadSafetyBC may request A Driver’s Medical Examination Report Additional information from the treating physician, or A neurological assessment. The neurological assessment may be conducted by the treating physician, if the physician has treated the patient for two years or more. However, if a neurological assessment by the treating physician does not provide the required information, RoadSafetyBC may request an assessment from a neurologist
Conditions for maintaining licence	None
Reassessment	RoadSafetyBC will re-assess in one year. If no further seizures are reported at that time, RoadSafetyBC will re-assess in accordance with routine commercial re-assessment
Information from health care providers	Date of the seizure Description of the type of seizure Whether a neurological assessment has been conducted and the results of the assessment
Rationale	The primary consideration for drivers who experience seizures is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving.The purpose of a seizure-free period requirement for an unprovoked seizure is to allow time to assess the cause and establish seizures are controlled as a prerequisite to driving

17.6.6 Epilepsy – Non-commercial drivers

This standard applies to non-commercial drivers who have been diagnosed with epilepsy, with the following exceptions:

If the epileptic seizures only occur while the driver is asleep, or immediately after awakening, standard 17.6.7 applies.
If the driver only experiences simple partial seizures, standard 17.6.8 applies.
If the driver has had surgery for epilepsy, standard 17.6.9 applies.
If the driver has changed effective medication, standard 17.6.11 applies.

National Standard	Non-commercial drivers eligible for a licence if: It has been 6 months since the seizure occurred with or without medication Waiting period may be reduced to no less than 3 months on neurologist`s recommendation if rationale is provided
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Reassessment	If a seizure occurred within the past 12 months, RoadSafetyBC will re-assess in one year If no further seizures are reported at that time, or if a seizure did not occur within the past 12 months, no re-assessment, other than routine age-related re-assessment, is required
Information from health care providers	Date of the last seizure Details of the driver’s treatment regime, including length of time the driver has been on antiepileptic medication Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The general approach of the guidelines for drivers with epilepsy or who experience seizures is that seizures must be controlled as a prerequisite to driving. The purpose of a seizure-free period requirement where epilepsy is diagnosed is to establish the likelihood that a therapeutic drug level has been achieved and maintained; the drug being used will prevent further seizures, and there are no side effects that may affect the individual’s ability to drive safely

17.6.7 Epilepsy with seizures only while asleep or upon awakening – Non-commercial drivers

National Standard	Non-commercial driver eligible for a licence if: It has been 6 months since the last seizure OR, The driver is experiencing seizures but seizure pattern has been consistent for at least 1 year- and therefore no seizure free waiting period required The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures You must routinely follow your physician’s advice regarding continued monitoring of your seizures You must report to RoadSafetyBC and your physician if the pattern of your seizures changes
Reassessment	No re-assessment, other than routine age-related re-assessment, is required
Information from health care providers	Description of the seizure pattern Whether the seizure pattern has been consistent for at least 1 years Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The purpose of a seizure-free period requirement for drivers with epilepsy with seizures only while asleep or upon awakening is to establish seizures are controlled or seizure pattern has been consistent for a prescribed time as a prerequisite to driving

17.6.8 Epilepsy with simple partial seizures – Non-commercial drivers

This standard applies to non-commercial drivers with epilepsy who only experience simple partial seizures (no impairment in level of consciousness), the symptoms of which do not impair their functional ability to drive.

National Standard	Non-commercial drivers eligible for a licence if: It has been 6 months since the last seizure OR, The driver is experiencing seizures but the seizure pattern has been consistent for at least 1 year- and therefore no seizure free waiting period required Favourable assessment from the treating physician or neurologist No impairment in level of consciousness or cognition No head or eye deviation with seizures The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures You must report to RoadSafetyBC and your physician if the symptoms of your seizures change
Reassessment	No re-assessment is required, other than routine age-related re- assessment
Information from health care providers	Date of last seizure Description of the symptoms of the seizures Whether the symptoms of the seizures have been consistent for at least 1 year Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The purpose of a seizure-free period requirement for drivers with epilepsy with simple partial seizures is to establish seizures are controlled or seizure pattern has been consistent for a prescribed time as a prerequisite to driving

17.6.9 Surgery for epilepsy – Non-commercial drivers

National Standard	Non-commercial drivers eligible for a licence if: They have not had a seizure for 12 months after surgery Taking anti-epileptic medication as directed by physician Waiting period may be reduced to 6 months upon neurologist recommendation The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Reassessment	If surgery for epilepsy has occured within 1 year of assessment, RoadSafetyBC will reassess in one year. If no seizures are reported at that time, no further re-assessment, other than routine age-related re- assessment, is required
Information from health care providers	Date of the last seizure Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The purpose of a seizure-free period requirement for drivers with epilepsy who had a surgery is to establish seizures are controlled as a prerequisite to driving

17.6.10 Surgery for Epilepsy – Commercial drivers

National Standard	Commercial drivers eligible for a licence if: They have not had a seizure for 5 years after surgery with or without anti-epileptic medication Waiting period may be reduced to 3 years upon neurologist/specialist recommendation Conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician,or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Restrictions	RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with epilepsy: R 22 (Code W) Class 1-4 Invalid in USA
Reassessment	If it has been 5 years or greater since surgery for epilepsy occurred AND no seizures are reported within that time, no further re-assessment, other than routine commercial. Wait period may be reduced to 3 years upon neurologist/specialist recommendation
Information from health care providers	Date of the last seizure Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The purpose of a seizure-free period requirement for drivers with epilepsy who had a surgery is to establish seizures are controlled as a prerequisite to driving.

17.6.11 Epilepsy with medication change – Non-commercial drivers

This standard applies to non-commercial drivers with epilepsy who undergo a prescribed change to, or withdrawal of, an effective antiepileptic medication. This standard only applies where the driver’s treatment was effective (i.e. their epilepsy was controlled) prior to the change to, or withdrawal from, medication. This means they should not have had a seizure for at least six months prior to the change or withdrawal of medication. If their treatment prior to the change was not effective, then guideline 17.6.6 applies.

National Standard	Non-commercial drivers eligible for a licence if: It has been 3 months since the change or withdrawal and they have not had a seizure during that time, and The conditions for maintaining a licence are met Non-commercial drivers who have a seizure after a change to, or withdrawal from, antiepileptic medication eligible for a licence if: They re-establish a previously effective treatment regime The treating physician indicates that further seizures are unlikely, It has been 3 months since the previously effective treatment regime was resumed and they have not had a seizure during that time The conditions for maintaining a licence are
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	Routinely follow treatment regime and physician’s advice regarding prevention of seizures Cease driving and report to the authority and your physician if you have a seizure
Reassessment	If a seizure occurred within the past 12 months, RoadSafetyBC will re-assess in one year If no further seizures are reported at that time, no further re-assessment, other than routine age-related re-assessment, is required
Information from health care providers	Date of the medication change or withdrawal Date of the last seizure Details of the driver’s treatment regime Opinion of treating physician whether the driver is compliant with their treatment regime Opinion of treating physician whether further seizures are likely
Rationale	The general approach of the guidelines for drivers with epilepsy or with medication change for epilepsy, or who experience seizures is that seizures must be controlled as a prerequisite to driving

17.6.12 Epilepsy – Commercial drivers

This standard applies to commercial drivers, who have been diagnosed with epilepsy, except:

Whose seizures only occur while they are asleep or immediately after awakening, and (17.6.13)
Who have only simple partial seizures (no impairment in level of consciousness), the symptoms of which do not impair their functional ability to drive (17.6.14).

See guideline 17.6.15 for commercial drivers who meet this standard and then change medication.

National Standard	Commercial drivers eligible for a licence if: They have not had a seizure with or without medication for 5 years, and The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or an assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Restrictions	RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with epilepsy R 22 (Code W) Class 1-4 Invalid in USA
Reassessment	RoadSafetyBC will re-assess in accordance with the schedule for routine commercial re-assessment
Information from health care providers	Date of the last seizure Details of the driver’s treatment regime, including length of time the driver has been on or off antiepileptic medication Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The general approach of the guidelines for drivers with epilepsy or who experience seizures is that seizures must be controlled as a prerequisite to driving. The purpose of a seizure-free period requirement where epilepsy is diagnosed is to establish the likelihood that a therapeutic drug level has been achieved and maintained; the drug being used will prevent further seizures, and there are no side effects that may affect the individual’s ability to drive safely

17.6.13 Epilepsy with seizures only while asleep or upon awakening – Commercial drivers

National Standard	Commercial drivers eligible for a licence if: The driver is experiencing seizures but the seizure pattern has been consistent for at least 5 years No prolonged postictal impairment in wakefulness
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or an assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if the pattern of seizures changes
Restrictions	RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with epilepsy R 22 (Code W) Class 1-4 Invalid in USA
Reassessment	RoadSafetyBC will re-assess in accordance with the schedule for routine commercial re-assessment
Information from health care providers	Description of the seizure pattern Whether the seizure pattern has been consistent for at least 5 years Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The primary consideration for drivers with epilepsy is the potential for a seizure causing a sudden impairment of cognitive, motor or sensory functions, or a loss of consciousness while driving. The general approach of the guidelines for drivers with epilepsy who experience seizures while asleep or upon awakening is to establish seizures are controlled or seizure pattern has been consistent for a prescribed time as a prerequisite to driving

17.6.14 Epilepsy with simple partial seizures – Commercial drivers

National Standard	Commercial drivers eligible for a licence if: It has been 5 years since the last seizure, or The driver is experiencing seizures but the seizure pattern has been consistent for 3 years – and therefore no seizure free waiting period required Favourable assessment from neurologist to drive No impairment in level of consciousness or cognition No head or eye deviation with seizures The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and You must cease driving and report to RoadSafetyBC and your physician if the symptoms of seizures changes
Restrictions	RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with epilepsy R 22 (Code W) Class 1-4 Invalid in USA
Reassessment	RoadSafetyBC will re-assess in accordance with the schedule for routine commercial re-assessment
Information from health care providers	Description of the symptoms of the seizures Whether the symptoms of the seizures have been consistent for at least 3 years Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime
Rationale	The purpose of a seizure-free period requirement for drivers with epilepsy with simple partial seizures is to establish seizures are controlled or seizure pattern has been consistent for a prescribed time as a prerequisite to driving

17.6.15 Epilepsy with medication change – Commercial drivers

This standard applies to commercial drivers with epilepsy who undergo a prescribed change to, or withdrawal of, an effective antiepileptic medication. This standard only applies where the driver’s treatment was effective (i.e. their epilepsy was controlled) prior to the change to, or withdrawal from, medication. This means they must first meet guideline 17.6.12 before this standard will apply.

National Standard	Commercial drivers eligible for a licence if: It has been 6 months since the prescribed change or withdrawal and they have not had a seizure during that time, and The conditions for maintaining a licence are met Commercial drivers who have a seizure after a prescribed change to, or withdrawal from antiepilectic medication are eligible for a licence if: It has been 6 months since the prescribed change or withdrawal and they have not had a seizure during that time They have re-established a previously effective treatment regime The treating physician indicates that further seizures are unlikely, and The conditions for maintaining a licence are met
BC Guidelines	If further information is required, RoadSafetyBC may request: A Driver’s Medical Examination Report Additional information from the treating physician, or An assessment from a neurologist
Conditions for maintaining licence	RoadSafetyBC will impose the following conditions on an individual who is found fit to drive: You must routinely follow your treatment regime and physician’s advice regarding prevention of seizures, and you must cease driving and report to RoadSafetyBC and your physician if you have a seizure
Restrictions	RoadSafetyBC will place the following restriction on an individual’s licence who meet the medical standard for commercial drivers with epilepsy R 22 (Code W) Class 1-4 Invalid in USA
Reassessment	RoadSafetyBC will re-assess in accordance with the schedule for routine commercial re-assessment
Information from health care providers	Date of the medication change or withdrawal Date of the last seizure Details of the driver’s treatment regime Opinion of treating physician on whether the driver is compliant with their treatment regime Opinion of treating physician on whether further seizures are likely
Rationale	The purpose of a seizure-free period. requirement for drivers with epilepsy with medication change is to establish seizures are controlled as a prerequisite to driving

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17 - Seizures and epilepsy - CCMTA Medical Standards