Changes from plenary report to adopted text

Added(1) Driving licences shall not be issued to, or renewed for, applicants or drivers with a serious neurological disease, unless the application is supported by a positive authorised medical opinion undertaken by a medical specialist or competent medical authority. [Am. 219]

AddedNeurological disturbances associated with developmental conditions, diseases, medical or surgical intervention affecting the central or peripheral nervous system, which lead to cognitive, behavioural, sensory or motor impairments and affect performance/function, balance and coordination, shall accordingly be taken into account in relation to their functional effects and. The risks of progression of impairment and compliance with treatment needs to be taken into account. In such cases, the issue or renewal of the licence may be subject to periodic assessment in the event of risk of deterioration. [Am. 220]

AddedOBSTRUCTIVE SLEEP APNOEA SYNDROME

Added(2) For the purpose of the following points:

Added‘moderate obstructive sleep apnoea syndrome’ means a number of apnoeas and hypopnoeas per hour (Apnoea-Hypopnoea Index) between 15 and 29;

Added‘severe obstructive sleep apnoea syndrome’ means an Apnoea-Hypopnoea Index of 30 or more, both associated with excessive daytime sleepiness.

Added(3) Applicants or drivers in whom a moderate or severe obstructive sleep apnoea syndrome is suspected shall be referred for further authorised medical advice before a driving licence is issued or renewed. They may be advised not to drive until confirmation of the diagnosis.

Added(4) Driving licences may be issued to applicants or drivers with moderate or severe obstructive sleep apnoea syndrome who show adequate control of their condition and compliance with appropriate treatment and improvement of sleepiness, if any, confirmed by authorised medical opinion.

Added(5) Applicants or drivers with moderate or severe obstructive sleep apnoea syndrome under treatment shall be subject to a periodic medical review, at intervals not exceeding three years for drivers of group 1 and one year for drivers of group 2, with a view to establish the level of compliance with the treatment, the need for continuing the treatment and continued good vigilance.

AddedEPILEPSY

Added12. Epileptic seizures or other sudden disturbances of the state of consciousness constitute a serious danger to road safety if they occur in a person driving a power-driven vehicle.

AddedFor the purpose of the following points:

Added‘epilepsy’ means a medical condition where the person concerned has had two or more epileptic seizures, less than five years apart;

Added‘provoked epileptic seizure’ means a seizure which has a recognisable causative factor that is avoidable.

AddedA person who has an initial or isolated seizure or loss of consciousness shall be advised not to drive. A specialist report is required, stating the period of driving prohibition and the requested follow-up.

AddedIt is extremely important that the person’s specific epilepsy syndrome and seizure type are identified so that a proper evaluation of the person’s driving safety can be undertaken (including the risk of further seizures) and the appropriate therapy instituted. This shall be done by a neurologist.

AddedGroup 1:

Added(1) Drivers assessed under group 1 with epilepsy shall be under licence review until they have been seizure-free for at least five years.

AddedIf the person has epilepsy, the criteria for an unconditional licence shall not be deemed to be met. Notification shall be given to the licensing authority.

Added(2) Provoked epileptic seizure: the applicant having had such a condition because of a recognisable provoking factor that is unlikely to recur at the wheel may be declared able to drive on an individual basis, subject to neurological opinion (the assessment shall be, if appropriate, in accordance with other relevant sections of Annex III (for instance in the case of alcohol or other co-morbidity)).

Added(3) First or single unprovoked seizure: the applicant who has had a first unprovoked epileptic seizure may be declared able to drive after a period of six months without seizures, if there has been an appropriate medical assessment. National authorities may allow drivers with recognised good prognostic indicators to drive sooner.

Added(4) Other loss of consciousness: the loss of consciousness shall be assessed according to the risk of recurrence while driving.

Added(5) Epilepsy: drivers or applicants may be declared fit to drive after a one-year period free of further seizures.

Added(6) Seizures exclusively in sleep: the applicant or driver who has never had any seizures other than seizures during sleep may be declared fit to drive so long as this pattern has been established for a period which must not be less than the seizure-free period required for epilepsy. If there is an occurrence of attacks/seizure arising while awake, a one-year period free of further event before licensing is required (see ‘Epilepsy’, in point 12.(5)).

Added(7) Seizures without influence on consciousness or the ability to act: the applicant or driver who has never had any seizures other than seizures which have been demonstrated exclusively to affect neither consciousness nor cause any functional impairment may be declared fit to drive so long as this pattern has been established for a period which shall not be less than the seizure-free period required for epilepsy. If there is an occurrence of any other kind of attacks/seizures a one-year period free of further event before licensing is required (see ‘Epilepsy’ in point 12(5)).

Added(8) Seizures because of a physician-directed change or reduction of anti-epileptic therapy: the patient may be advised not to drive from the commencement of the period of withdrawal and thereafter for a period of six months after cessation of treatment. Seizures occurring during physician-advised change or withdrawal of medication require three months off driving if the previously effective treatment is reinstated.

Added(9) After curative epilepsy surgery: see ‘Epilepsy’ in point 12.(5).

AddedGroup 2:

Added(10) The applicant shall be without anti-epileptic medication for the required period of seizure freedom. An appropriate medical follow-up shall have been carried out. Extensive neurological investigation shall have shown that there is neither a relevant cerebral pathology nor any epileptiform activity on the electroencephalogram (EEG). An EEG and an appropriate neurological assessment shall be performed after the acute episode.

Added(11) Provoked epileptic seizure: the applicant who has had a provoked epileptic seizure because of a recognisable provoking factor that is unlikely to recur at the wheel may be declared able to drive on an individual basis alone and for vehicles for private use but not for the transport of others, subject to neurological opinion. An EEG and an appropriate neurological assessment shall be performed after the acute episode. [Am. 222]

AddedA person with a structural intra-cerebral lesion who has increased risk of seizures shall not be able to drive vehicles of group 2 until the epilepsy risk has fallen to at least 2 % per annum. The assessment shall be, if appropriate, in accordance with other relevant sections of Annex III (for instance in the case of alcohol).

Added(12) First or single unprovoked seizure: the applicant who has had a first unprovoked epileptic seizure may be declared able to drive once five years’ freedom from further seizures has been achieved without the aid of anti-epileptic drugs, if there has been an appropriate neurological assessment. National authorities may allow drivers with recognised good prognostic indicators to drive sooner. [Am. 223]

Added(13) Other loss of consciousness: the loss of consciousness shall be assessed according to the risk of recurrence while driving. The risk of recurrence shall be 2 % per annum or less.

Added(14) Epilepsy: 10 years freedom from further seizures shall have been achieved without the aid of anti-epileptic drugs. National authorities may allow drivers with recognised good prognostic indicators to drive sooner. This shall also apply in case of ‘juvenile epilepsy’.

AddedCertain disorders (for instance arteriovenous malformation or intra-cerebral haemorrhage) entail an increased risk of seizures, even if seizures have not yet occurred. In such a situation an assessment shall be carried out by a competent medical authority; the risk of having a seizure shall be 2 % per annum or less to allow licensing.

AddedMENTAL IMPAIRMENTS

Added13. The following rules apply to applicants or drivers with mental or intellectual impairment.

AddedGroup 1:

Added(1) Driving licences shall not be issued to, or renewed for, applicants or drivers with:

Added(a) severe mental, cognitive or behavioural impairment, whether congenital or due to disease, trauma or neurosurgical operations; [Am. 224]

Added(b) severe intellectual impairment; [Am. 225]

Added(c) severe behavioural problems, ageing-linked behavioural problems; or personality impairments leading to seriously impaired judgment, behaviour or adaptability, [Am. 226]

Addedunless their application is supported by authorised medical opinion and, if necessary, subject to regular medical check-ups.

AddedGroup 2:

Added(2) The competent medical authority shall give due consideration to the additional risks and dangers involved in the driving of vehicles covered by the definition of this group. The competent medical authority may establish temporary requirements or impose restrictions on driving. [Am. 227]

AddedALCOHOL

Added14. Alcohol consumption constitutes a major danger to road safety. In view of the scale of the problem, the medical profession must be very vigilant.

AddedGroup 1:

Added(1) Driving licences shall not be issued to, or renewed for, applicants or drivers who are dependent onhave alcohol use disorders or areor unable to refrain from drinking and driving unless appropriate restrictions are applied through their participation in rehabilitation programmes including monitoring and medical supervision and the use of technologies enabling to offset the dependency (for example,including through the mandatory use of an alcohol interlock). [Am. 228]

AddedAfter a proven period of abstinence and subject to a positive authorised medical opinion and regular medical check-ups by the competent medical authority, driving licences may be issued to, or renewed for, applicant or drivers who have in the past been dependent on alcohol with no further restrictions. [Am. 229]

AddedGroup 2:

Added(2) The competent medical authority shall give due consideration to the additional risks and dangers involved in the driving of vehicles covered by the definition of this group.

Added(2a) The competent medical authority may establish temporary requirements and, where appropriate, restrictions on driving. [Am. 230]

AddedDRUGS AND MEDICINAL PRODUCTS

Added15. The following rules apply to drugs and medical products.

AddedAbuse:

Added(1) Driving licences shall not be issued to or renewed for applicants or drivers who are dependent onmake use of psychotropic substances or who are not dependent on such substances but regularly abuse themnarcotics or, whatever category of licence is requested. [Am. 231]

AddedRegular use:

AddedGroup 1:

Added(2) Driving licences shall not be issued to, or renewed for, applicants or drivers who regularly useabuse or make regular use of psychotropic substances, in whatever form, which can hamper if the quantity taken is such as to influence the ability to drive safely where the quantities absorbed are such as to have an adverse effect on driving. This shall apply to all other medicinal products or combinations of medicinal products which affect the ability to drive.