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PubMed2003

Antidepressants and driver impairment: empirical evidence from a standard on-the-road test.

BACKGROUND AND METHOD: The current review summarizes the major results from all published studies from 1983 to 2000 (9 double-blind, crossover, placebo-controlled studies in healthy volunteers and 1 double-blind, baseline-controlled study in patients) that have determined the effects of antidepressants on actual driving performance using a standard test. That test measures driving impairment from vehicular "weaving" (i.e., standard deviation of lateral position [SDLP]) during 1 hour of on-the-road driving in normal traffic. RESULTS: Changes in SDLP after acute doses of sedating antidepressants (i.e., amitriptyline, imipramine, doxepin, and mianserin) were comparable to those seen in drivers conducting the same test with a blood alcohol concentration of 0.8 mg/mL or more. Driving performance of subjects returned to placebo levels after 1 week of treatment, except after treatment with mianserin, for which the impairing effect lasted unabated over treatment. Nocturnal doses of sedating antidepressants (i.e., dothiepin, mianserin, and mirtazapine), however, did not produce residual driving impairment when measured the next day. Nonsedating antidepressants (i.e., moclobemide, fluoxetine, paroxetine, venlafaxine, and nefazodone) generally did not affect SDLP. However, SDLP rose to unacceptable levels after administration of combinations of nonsedating antidepressants and benzodiazepines with incompatible pharmacokinetic profiles. Correlational analyses demonstrated that conventional tests of psychomotor performance or self-ratings of side effects did not strongly predict antidepressant effects on SDLP. Regression analysis revealed a strong linear relation between antidepressant effects in the standard driving test and the number of patients reporting somnolence in clinical trials with the same antidepressants. CONCLUSION: Application of actual driving tests remains essential to conclusively defining the potential hazard of drugs for driving.

Accidents, Traffic↗
PubMed2003

[Epilepsy and driving in Argentina. A new proposal].

Current laws and regulations concerning epilepsy patients and driving exist in different countries all over the world. Patient's seizure-free intervals, physician's responsibilities, type of seizures and other requirements make these laws and regulations vary from country to country and even from state to state in the same country. In Argentina, in law No. 24.449, Decree Regulation No. 779/95, article 33 on Physical Aptitude, epilepsy is included, and the NE02 code "bans" anyone with epilepsy from being licensed; while NE03 "bans" anyone with an abnormal electroencephalogram. Based on laws from Argentina and foreign countries regarding driving and other issues that concern people with epilepsy, we propose that: 1) Physicians must counsel patients on their responsibilities over their disease and driving, and document on the medical record that this has been done. 2) Patients must take 1-year seizure-free period before being licensed again. 3) Patients are compelled to an annual medical update and to disclose the antiepileptic drugs (AED's) they are taking. 4) Driving restriction for patients having their AED's reduced or switched, during that period and up to six-months after finishing the process. 5) Doctors are not obliged to report to the State cases with seizures or epilepsy. 6) In paragraph "Neurological Aptitudes Criteria", about NE02 and NE03 Codes, the expression "inept" should be switched to "to be evaluated". 7) Ban a person with any history of seizure or epilepsy from being licensed to drive school buses, trucks and public transportation. These changes in our regulations will have the following advantages: 1) An increase in the number of reports to Motor Vehicle Authorities. 2) An improvement of the clinical/neurological controls. 3) They also will avoid, in great proportion, seizure-related motor vehicle crashes and property damage. 4) The up-dating of our laws/regulations/codes. 5) Not only because of medical, but also for its legal and social implications: a) protect physicians from being drawn into the legal foray, b) epileptic patients are legally protected, c) increase the security in the streets and therefore in our community.

Accidents, Traffic↗
PubMed2003

[Fitness-to-drive in neurological disorders].

Driving-license holders with health problems are morally obliged to report this to the Driver Licensing Centre (CBR). The CBR can then further investigate the matter and either insist that technical modifications be made to the vehicle or declare the driver (temporarily) unfit to drive a vehicle. After an epileptic seizure a driver may not drive a car or ride a motorcycle for six months. Following multiple seizures this period is extended to one year after the last seizure. Exceptions can be made only if certain established criteria are fulfilled. Following cerebral infarction or cerebral haemorrhage, the driving-license holder is considered unfit to drive for at least six months. After this period fitness-to-drive is dependent on the presence of any disorders of function and the results of a CBR driving test. Persons with an intracranial tumour are assessed on the presence of any disorders of function and may be given a driving license valid for a limited period of time only. A transient ischaemic attack (TIA) or the chance discovery of an unruptured intracranial aneurysm or vascular malformation which does not need treatment, does not necessarily affect fitness to drive. Persons with syncope, progressive neurological disorders or stationary functional disorders should undergo medical assessment and, if necessary, take a CBR driving test. In the case of all neurological disorders, the rules are stricter for professional drivers of cars and motorcycles as well as holders of driving licenses for heavy-goods vehicles and buses.

Automobile Driver Examination↗
PubMed1978

Assessing the driving potential of the handicapped.

Proper and early assessment of the handicapped person's potential for driving a vehicle depends upon an understanding of the factors involved in a driver evaluation. The driver evaluation factors discussed in this paper are: driving aids and their application; the handicapped driver's physical, perceptive, and cognitive capabilities; and the psychosocial characteristics that influence a client's ability and need for driving.

Automobile Driver Examination↗
PubMed2004

[Visual aptitude for automobile driving].

Visual function is crucial in driving and is one of the links which determine the medical aptitude to this activity. The ophthalmologist has important medical and moral responsibilities and has more than one mission in the determination of the aptitude to driving. The evaluation of the aptitude of the (future) driver is based on different legal criteria (Belgian Royal Orders dated on 23-03-1998 and 05-09-2002) whose requirements are in accordance with EC reglementation and are different according as the motor vehicles are used for private or professional purposes. Social and psychological consequences of driving incapacity may be important as far as the real impact of vision alterations on the incidence of motor vehicle crashes is still to be clearly determined. The knowledge of the repercussions of different diseases such as ametropia, age related effects, loss of vision in one eye, cataract, glaucomatous neuropathy, laser treatments,... on car driving can help the ophthalmologist to improve his judgment on the patient's real driving aptitude and the quality of his counselling if needed.

Accidents, Traffic↗
PubMed2004

[The role of CARA for assessment of visual problems].

The text specifies the role of CARA (Centre of Fitness to drive and Car adaptations) in the assessment of the fitness to drive an automobile. From the visual point of view, an assessment of the repercussions of a reduced field of vision on fitness can (if the ophthalmologist is in favour) be made by testing it on a public road.

Accidents, Traffic↗
PubMed2004

[Disagreement about epilepsy and driving].

BACKGROUND: To find out how current regulations concerning epilepsy and driving licence are applied in clinical practice in Norway. MATERIAL AND METHODS: A questionnaire was sent to all 344 members of the Norwegian Neurological Association. RESULTS: 56% responded within 3 months, most of them (152) working in the field of clinical neurology. The majority (73%) did not see reporting a "situation-related" seizure to the authorities as obligatory, but almost all of these respondents (94%) would temporarily disallow driving. 60% did not consider it obligatory to report the exclusive occurrence of simple partial seizures with retained consciousness and motor control. A surprisingly large number (36%) would never recommend dispensation from the rule instituting a one-year driving ban. 39% generally used EEG in the assessment of driving fitness, whereas 17 % rarely did so. Only 50% instructed their patients not to drive during antiepileptic drug withdrawal. 45% did not consider seizure recurrence resulting from consented withdrawal to activate the obligation to report. CONCLUSION: There is poor consensus among neurologists on many aspects of driving and epilepsy, particularly on the assessment of risk when drugs are withdrawn. These issues should be focused on in graduate and postgraduate education in clinical neurology.

Anticonvulsants↗
PubMedDate not supplied

[Elderly and brain-damaged drivers in Spain].

AIM: The number of drivers and vehicles crossing our roads increases every year. Driving a car requires cognitive, psychomotor and psychological aptitudes and abilities that they should be assessed when the driving license is getting. DEVELOPMENT: The current expectancy of life implies the increasing number of elderly people as drivers. The survival of brain injured people has increased because of scientific and technological improvements. The cognitive, emotional and behavioral sequelae of brain injury could influence in the ability to drive. However, the measures of this driving ability are not yet well established. CONCLUSION: Having in mind the legal dispositions, we would like to analyse the psychometric tests administering to get the driving licence and their sensitivity to assess brain injured people. It is also important to know how to manage cognitive deterioration drivers.

Accidents, Traffic↗
PubMed2004

An evaluation of the effectiveness of the supervised driver-training system in France.

This paper presents an evaluation of the effectiveness of the French Apprentissage Anticipé de la Conduite (AAC), which is an optional initial driver training that seeks to reduce accident risk by novice drivers. The effectiveness of the AAC is estimated using a Case-Control study (521 Cases and 624 Controls) and the adjusted Odds ratio (AAC versus regular) from a multivariate logistic regression. Thirteen risk factors are retained as explanatory variables in the regression. An Odds ratio of 0.9 indicates a non-significant reduction in accident involvement of AAC participants in the two years following the acquisition of their driver's license. The discussion addresses the possible reasons underlying the lack of result, e.g. an absence of varied experience during the AAC period and possible undesirable effects under supervision such as a partial delegation of responsibility for driving tasks by the young driver to the supervisor. Our recommendations include that AAC be integrated into a gradual licensing scheme, and should focus on the gradual acquisition of various driving experiences (in terms of variety of driving situations).

Adolescent↗
PubMed2002

The development and clinical trial of a Driving Simulator for the handicapped.

We developed a Virtual Reality Driving Simulator in order to safely evaluate and improve the driving ability of the handicapped. The Virtual Environment consists of 18 sections (e.g. a speed limited road, a strait road, a curved road, a left turn course, etc) and each section is linked naturally. For the interface of our driving simulator, an actual car was adapted for realism and then connected to a computer. We also equipped it with hand control driving devices especially adapted for the handicapped. A beam projector was used so that the subjects could see the virtual scene on a large screen which was set in front of them. The subjects selected for this trial were 10 normal drivers with valid driving licenses and 15 patients with thoracicor lumber cord injuries who had prior driving experience. For evaluation, 5 driving skills were measured including average speed, steering stability, centerline violations, traffic signal violations, and driving time in various road conditions such as strait and curved roads. The normal subjects manipulated the gas pedal and the brake with their feet while the patients manipulated a hand control with their hands. After they finished driving the whole course, the participants answered the questions such as "How realistic did the Virtual Reality Driving Simulator seeme to you?" and "How much was your fear reduced". The five driving skills measured between the two groups (normal vs. handicapped) did not show any significant differences (p > 0.05). And in the three kinds of road conditions (a speed limited road and roads with a sharp curve and left-hand turn), the average speed of the handicapped group was 45.6 Km, less than 61.2 Km (p<0.05) of the normal group. In all, 11 patients (73%) reported that their fear of driving was reduced. Furthermore, their average score on the degree of realism question was 51.5%.

Adult↗
PubMed2004

Epilepsy and driving in Belgium: proposals and justification.

Proposals about the regulations and medical criteria concerning epilepsy and driving, originally drawn up by the Commission on Epilepsy and Risk from the Belgian League against Epilepsy were discussed and amended by a panel of representatives of several scientific societies and of all Belgian universities in order to establish a broad consensus among Belgian epileptologists. The history of driving licencing in Belgium is discussed and some background information given to put the regulations in perspective. A proposal is made for an acceptable level of risk. Subsequently, a quantification of risk for different situations concerning seizures is attempted. The proposals will be discussed and some further practical advice given. Individual assessment of the ability to drive remains indispensable.

Automobile Driver Examination↗