In the United Kingdom, it is the DVLA who determine the regulations with regard to driving when there has been loss of consciousness. It is a self-reporting system but failure to declare a problem to DVLA is both illegal and would invalidate any insurance policy. I can only urge anyone who has lost consciousness that is a real risk particularly to other people if you continue to drive. It is the requirement of doctors to inform patients that there are specific regulations. Usually the doctor will not report the patient to DVLA but under special circumstances when there is a deliberate and definite failure by the patient to listen to the advice, then the doctor does have a duty to society to protect other people.
It is essential that a proper diagnosis is made as the driving regulations and restriction on driving depend on that diagnosis. Unfortunately many patients that I see have not been given the appropriate advice which is unfortunate.
1. If the attacks are benign in nature and if there is a definite factor with associated preceding symptoms with the attacks not occurring while sitting or lying, then no driving restriction is required for an ordinary driving licence or vocational, that is public service vehicle licence.
1. Loss of consciousness likely to be unexplained fainting with a low risk of reoccurence. With
these episodes, the patient should have little or no abnormality as far as the cardiovascular
system is concerned. A neurological examination should be normal with no suggestion of epilepsy. There should be a normal ECG. A Group I licence has a four week restriction.
A Group 2 licence has a three month restriction before driving can be reviewed.
2. Loss of consciousness likely to be unexplained fainting but a high risk of reoccurrence.
The high risk is indicated by the following.
1. An abnormal ECG.
2. Evidence of structural heart disease
3. Fainting causing injury or occurring actually whilst at the wheel of the vehicle
or while sitting or lying
4. More than one episode in the previous six months.
In these circumstances, a specialist opinion should be sought and almost certainly ambulatory ECG over 48 hours (electrical recording of the heart), echocardiography (an ultrasound test looking at the heart valves and muscle) and an exercise test would probably need to be carried out.
Group I licence can drive four weeks after the event if the cause identified and treated. If no cause identified, then six months restriction of driving. Group 2 licence can drive after three months if the cause identified and treated. If no cause identified, then the licence should be revoked for one year.
5. Unwitnessed, therefore a presumed loss of consciousness with features suggesting epilepsy.
In this group, a strong clinical suspicion of epilepsy but no definite evidence. The following
a) Unconsciousness for more than five minutes
b) Amnesia (that is no memory of the event) for greater than five minutes
e) Remaining unconscious but with confused behaviour
f) Headache after the attack.
This group is in effect for those people for whom epilepsy is not a definite diagnosis but
there is a strong suspicion.
Group 1 licence - one year loss of licence.
Group 2 licence - five years loss of licence.
6. Loss of consciousness with no clinical indication as to cause.
In this group of patients, there will have been a full appropriate neurological and cardiac
opinion with all investigation showing no abnormality. Remarkably unfortunately this is
not an uncommon situation. Group 1 licence - loss of licence for six
Group 2 licence - loss of licence for one year.
7. Psychogenic attacks.
If there is a diagnosis of psychogenic attacks, then as the diagnosis has been made, a licence
can be reissued if the attacks have stopped.