1988 Conference on Neurological Disorders and Commercial Drivers: The previous advisory criteria before the exemption provided that “drivers with a history of epilepsy/seizures off anti-seizure medication and seizure free for 10 years may be qualified to drive a commercial motor vehicle (CMV) in interstate commerce”. Interstate drivers with a history of single unprovoked seizure may be qualified to drive a CMV in interstate commerce if seizure free and off anti seizure medication for a 5 year period or more. This medical advisory was based on the “1988 Conference on Neurological Disorders and Commercial Drivers“.
2007 Medical Expert Panel: The FMCSA decided to use the 2007 Medical Expert Panel (MEP) recommendations as the basis for evaluating applications for an exemption from the seizure regulation on an individual case by case basis. Of note, when the 2007 Medical Panel Recommendations were presented to the Medical Review Board (MRB), they decided to maintain the current criteria which was based on the “1988 Conference on Neurological Disorders and Commercial Drivers” described above. The FMCSA decided to use the 2007 MEP recommendations instead and on January 15, 2013 the Federal Motor Carrier Safety Administration granted exemptions to 22 individuals from the regulation or standard found in 391.41(b)(8), which states that commercial motor vehicle operators should “have no established medical history or clinical diagnosis of epilepsy or any other condition which is likely to cause loss of consciousness or any loss of ability to control a commercial motor vehicle”. This allowed 22 individuals who take anti-seizure medication to operate a commercial motor vehicle in interstate commerce for a period of 2 years, thus exempting them from the regulatory requirement. Without the exemption these individuals would have been restricted to intrastate commerce.
Medical background on the drivers receiving exemption: The FMCSA was clear to point out that they are not granting exemptions to drivers with recent seizures and that each case is evaluated on an individual basis. Of the 22 drivers granted the exemption, 20 out of 22 currently take anti-seizure medication (thus they would have been not qualified based on the 1988 criteria to be off seizure medications in order to drive in interstate commerce); 2 drivers out of 22 of the drivers had a diagnosis of epilepsy (however, these 2 drivers only had a single seizure, raising questions as to whether or not they actually had epillepsy). Furthermore, those 2 drivers were seizure free for more than 21 years. Five drivers of the remaining twenty have been seizure free for more than 20 years and 15 drivers for more than 4 years. Finally, seven of the 20 drivers had one provoked or unprovoked seizure from a head injury, a medical procedure, or other known cause.
Evidence Report on Seizure Disorders and Commercial Vehicle Driving: The FMCSA largely reached this decision based on both current information and medical information gathered by the 2007 Medical Experts Panel (MEP). The agency used it’s own review of the scientific literature which was compiled in a report called “Evidence Report on Seizure Disorders and Commercial Vehicle Driving” and the recommendations from the MEP physicians in the field of neurology to review the epilepsy standard 391.41 (b) (8). The FMCSA based their final decision on an individual basis, taking into consideration such factors as the cause of the individual’s seizure, date of last seizure, and treatment regimen. The driving record of these individuals were also reviewed in the Commercial Driver Licensing Information System(CDLIS), and from the Motor Carrier Management Information System (MCMIS).
MEP Recommendations and Guidelines: Guideline 1 (Epilepsy); Guideline 2 (Single unprovoked seizure); Guideline 3 (Single provoked seizure)
1. Epilepsy: (includes individuals who may have underlying epilepsy such as those with seizures triggered by photic stimuli, sleep deprivation or certain visual stimulation patterns).
- Individual with diagnosis of epilepsy need to be seizure free for 8 years, on or off medications.
- If using medications must be stable for 2 years ( i.e no change in medication dosage or frequency)
- Recertification every year
2. Single unprovoked seizure (no known trigger for seizure):
- Seizure free for 4 years on or off medications
- If using mediations must be stable for 2 years
- Recertification every 2 years
3. Single provoked seizure (cause of seizure is known):
- Low risks factors: seizures caused by medications (i.e lidocaine injection), non-penetrating head injury with loss of consciousness (LOC) less than or equal to 30 minutes; by a brief LOC not likely to recur while driving, and by metabolic derangement not likely to recur, and by alcohol or illicit drug use withdrawal. Certify for 1 year then re-certify yearly.
- Moderate to high risk factors: seizures caused by non-penetrating head injury with loss of consciousness or amnesia greater than 30 minutes, or penetrating head injury, intracranial hemorrhage associated with stroke trauma or any other etiology, brain infections, post operative complications from brain surgery with significant hemorrhage, brain tumor or stroke. Conditional certification may be considered if seizure free on or off medications for minimum of 8 years. If on medications must be on stable regimen for minimum of 2 years. Recertification every year.
- Contingent on driver maintaining a stable treatment regimen and remaining seizure free during the 2 year exemption period
- Submit annual reports from their treating physician to attest to stability of treatment and that driver has remained seizure free.
- Annual medical examination by a medical examiner