Autonomic Mediated Syncope and Driving.

Patients in the UK have a legal duty to inform the DVLA about any condition likely to affect their ability to drive safely. The address to write to is:

Driver and Vehicle Licensing Agency, Longview Road, Morriston, Swansea. SA99 1TU.

Where the individual concerned is uncertain about the need to contact the DVLA, he/she should seek advice from their GP or relevant specialist or contact the DVLA directly ( Car licence – Group 1 Entitlement – 0870 600 0301; lorry/bus driver – Group 2 Entitlement – 0870 241 1879) for advice. Failure to notify their insurance company may also affect the validity of his/her insurance. This includes life insurance and health insurance as well as car insurance.

When a patient contacts the DVLA, he/she may be informed that they may continue to drive (Section 88 of the Road Traffic Act) whilst investigations are being undertaken provided they have not been advised to cease doing so by their GP and/or specialist (and have actively sought that opinion) and hold a valid driving licence.

The doctor’s duty is to advise his/her patient when they should cease to drive  and notify the DVLA. Where the doctor is uncertain he/she should consult “At a Glance Guide to the Current Medical Standards of Fitness to Drive”, whether in its hard copy format or on the DVLA website for the latest guidelines.

Doctors may consult with the DVLA Medical Advisors on an anonymous case basis OR on a named basis with the individual’s permission OR when there is evidence that an individual continues to drive despite being advised that he/she is unfit to do so. The GMC has produced specific guidelines on this aspect.

DVLA guidelines for syncope were recently updated – November 2014 – and are presented below.

 


 
Group 1 Entitlement Group 2 Entitlement
1. Reflex Vasovagal SyncopeDefinite provocational factors with associated prodromal symptoms and which are unlikely to occur whilst sitting or lying.

Benign in nature.

If recurrent, will need to check the “3 Ps” apply on each occasion (provocation/prodrome/postural).

(If not see Number 6 below).

No driving restrictions.

DVLA need not be notified.

No driving restrictions.

DVLA need not be notified.

2. Loss of consciousness/ loss of or altered awareness likely to be unexplained syncope but with a high probability of reflex vasovagal syncope.These have no clinical evidence of structural heart disease and a normal ECG. No driving restrictions.

DVLA need not be notified.

Can drive 3 months after the event
3. Solitary loss of consciousness/ loss of or altered awareness likely to be cardiovascular in origin (excluding 1 or 2).

Factors indicating high risk:
(a) abnormal ECG

(b) clinical evidence of structural heart disease
(c) syncope causing injury, occurring at the wheel or whilst sitting or lying
Further investigations such as ambulatory ECG (48hrs), echocardiography and exercise testing may be indicated after specialist opinion has been sought.

Licence refused/revoked for 6 months if no cause identified.

Can drive 4 weeks after the event if the cause has been identified and treated.

Licence refused/revoked for 12 months if no cause identified.

Can drive 3 months after the event if the cause has been identified and treated.

 

 

4. Solitary loss of consciousness/loss of or altered awareness with seizure markers.

This category is for those where there is a strong clinical suspicion of a seizure but no definite evidence.

Factors to be considered:

- without reliable prodromal symptoms

- unconsciousness for more than 5 minutes

- amnesia longer than 5 minutes

- injury

- tongue biting

- incontinence

- remain conscious but with confused behaviour

- headache post attack

6 months off driving from the date of an episode of loss of consciousness/loss of or altered awareness.

If a person has a history of epilepsy, an isolated seizure or a loss of consciousness/loss of or altered awareness with seizure markers within the preceding 5 years, then a period of 1 years’ freedom from any such events must be demonstrated before being considered eligible to drive.

5 years off driving from the date of an episode if the licence holder has undergone assessment by an appropriate specialist and no relevant abnormality has been identified on investigation, for example EEG and brain scan, where indicated.

If a person has a history of epilepsy, an isolated seizure or a loss of consciousness/loss of altered awareness with seizure markers within the preceding 10 years then a period of 10 year’s freedom from any such events must be demonstrated before being considered eligible to drive.

5. Solitary loss of consciousness/loss of or altered awareness with no clinical pointers.

This category will have had appropriate neurological and cardiac opinion and investigations but with no abnormality detected.

Licence refused/revoked for 6 months. Licence refused/revoked for 1 year.
6. Two or more episodes of loss of consciousness/loss of or altered awareness without reliable prodromal symptoms. If the episodes have been within the last 5 years then licence revoked or refused for 12 months or until the risk has been reduced to <20% per annum. If the episodes have been within the last 10 years then licence revoked or refused for 10 years or until the risk has been reduced to less that 2% per annum.
 

 

Group 1 Entitlement Group 2 Entitlement
PACEMAKER IMPLANT
Includes box change
Driving must cease for at least 1 week Disqualifies from driving for 6 weeks