Neurological disorders: assessing fitness to drive
Source: gov.uk (2025-11-07)

Advice for medical professionals to follow when assessing drivers with neurological disorders.

Serious neurological disorders

Changes to Annex III to the EC Directive 2006/126/EC require that driving licences may not be issued to, or renewed for, applicants or drivers who have a serious neurological disorder unless there is medical support from their doctors.

A serious neurological disorder is considered as:
- any condition of the central or peripheral nervous system presently with, or at risk of progression to a condition with, functional (sensory (including special senses), motor and/or cognitive) effects likely to impact on safe driving
Further information relating to specific functional criteria is provided on:
- specific neurological conditions in this section (neurology)
- cognitive and related conditions (https://www.gov.uk/guidance/psychiatric-disorders-assessing-fitness-to-drive)
- visual conditions and disorders (https://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive)
- excessive sleepiness (https://www.gov.uk/guidance/miscellaneous-conditions-assessing-fitness-to-drive#excessive-sleepiness--including-obstructive-sleep-apnoea-syndrome)
When considering licensing for these customers, the functional status and risk of progression will be considered. A short term medical review licence is generally issued when there is a risk of progression.

Epilepsy and seizures

Appendix B (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-b-epilepsy-and-seizure-rules-and-further-guidance) sets out the relevant regulations.

The following definitions apply:
- epilepsy encompasses all seizure types, including major, minor and auras
- if within a 24-hour period more than one epileptic event occurs, these are treated as a single event for the purpose of applying the epilepsy and seizure regulations
- from a licensing perspective, epilepsy means 2 or more unprovoked seizures over a period which exceeds 24 hours and less than five years apart
- epilepsy is prescribed in legislation as a relevant disability where there have been 2 or more epileptic seizures during the previous 5 year period
- isolated seizure means one or more unprovoked seizures within a 24 hour period, or one or more unprovoked seizures within a 24 hour period where that period of seizure has occurred more than 5 years after the last unprovoked seizure
The following features, in both Group 1 car and motorcycle and Group 2 bus and lorry drivers, are considered to indicate a good prognosis for a person under care for a first unprovoked or isolated epileptic seizure:
- no relevant structural abnormalities on brain imaging
- no definite epileptiform activity on EEG
- support of a neurologist
- annual risk of seizure considered to be 2% or lower for bus and lorry drivers
Special considerations

Here are the special considerations.

Group 1 car and motorcycle

The following special considerations apply to drivers of cars and motorcycles:
- The person with epilepsy may qualify for a driving licence if they have been free from any seizure for 1 year. This needs to include being free of minor seizures, including those that do not involve a loss of consciousness, and epilepsy signs such as limb jerking, auras and absences.
- The person who has had a seizure while asleep must stop driving for 1 year from the date of the seizure unless point 3 or 5 apply.
- Relicensing may be granted if the person, over the course of at least 1 year from the date of the sleep seizure, establishes a history or pattern of seizures occurring only ever while asleep.
- Relicensing may be granted if the person, over the course of at least 1 year from the date of the first seizure, establishes a history or pattern of seizures which affect neither consciousness nor cause any functional impairment. The person must never have experienced any other type of unprovoked seizure.
- Regardless of preceding seizure history, if a person establishes a pattern of asleep seizures only (all seizures had onset during sleep), starting at least 3 years prior to licence application and there have been no other unprovoked seizures during those 3 years, a licence may be issued.
Overriding all of the above considerations is that the licence holder or applicant with epilepsy must not be regarded as a likely source of danger to the public while driving and that they are compliant with their treatment and follow up.

If the licensed driver has any epileptic seizure, they must stop driving immediately unless DVLA has established that considerations 3, 4 or 5 can be met, and they must notify DVLA.

If a licence is issued under considerations 3, 4 or 5 and the driver has a different type of seizure, they lose the concession, must stop driving, and must notify DVLA.

Isolated seizures

An isolated seizure is an unprovoked seizure experienced by a person who has not had any other unprovoked seizures during the preceding 5 years. A person who has an isolated seizure will qualify for a driving licence if they are free from any further seizure for 6 months, unless there are clinical factors or results of investigations suggesting an underlying causative factor that may increase the risk of a further seizure, in which case 12 months is required before relicensing.

Withdrawal of epilepsy medication (also see Appendix B (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-b-epilepsy-and-seizure-rules-and-further-guidance))

Individuals should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose.

For a driver with epilepsy, if a seizure occurs within 6 months of, and because of a documented physician-advised substitution, reduction or withdrawal of anti-epilepsy medication, the regulations allow relicensing prior to the usual 12 month post-seizure period. Earlier relicensing may be considered if previously effective medication has been reinstated for at least 6 months and the driver has remained seizure free for at least 6 months.

Seizures associated with transcranial magnetic stimulation (TMS)

Single-pulse TMS - a seizure occurring during or after single-pulse TMS administration is considered to be an unprovoked seizure. The seizure regulations will apply.

Repetitive TMS (rTMS) - a seizure occurring during or within 5 minutes of cessation of rTMS is considered to be a provoked seizure. Such seizures do not necessitate driving cessation. See Appendix B (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-b-epilepsy-and-seizure-rules-and-further-guidance).

Group 2 bus and lorry

Drivers of buses and lorries must satisfy all of the following conditions under the regulations. They must:
- hold a full ordinary driving licence
- have been free of epileptic seizures for the last 10 years
- not have taken any medication to treat epilepsy during these 10 years (there are thus no special considerations for withdrawal)
- have no continuing increased risk of epileptic seizures
- not be a source of danger whilst driving
Isolated seizure

Drivers of buses and lorries must satisfy all the following conditions in relation to an isolated seizure. They must:
- hold a full ordinary driving licence
- have been free of epileptic attacks for the last 5 years
- not have taken any medication to treat epilepsy or a seizure during these 5 years
- have undergone a recent assessment by a neurologist
- have no continuing increased risk of seizures
Transient loss of consciousness (‘blackouts’) – or lost or altered awareness – including blackouts with seizure markers and cough syncope

Refer to Appendix D (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-d-transient-loss-of-consciousness-blackouts-and-lost-or-altered-awareness)

Primary/central hypersomnias – including narcolepsy type 1 (narcolepsy with cataplexy) and type 2

For other causes of excessive sleepiness, see the guidance on miscellaneous conditions (https://www.gov.uk/guidance/miscellaneous-conditions-assessing-fitness-to-drive).

*The on-road assessment should require a minimum period of 90 minutes driving in an appropriate vehicle.

Chronic neurological disorders – including multiple sclerosis and motor neurone disease

Any chronic neurological disorder that may affect vehicle control because of impaired coordination and muscle strength.

For information on in-car driving assessments for those with a disability, see Appendix H (https://www.gov.uk/guidance/appendices-assessing-fitness-to-drive#appendix-h-mobility-centres-and-driving-assessment-centres).

Parkinson’s disease

Dizziness – liability to sudden and unprovoked or unprecipitated episodes of disabling dizziness

Sudden is defined as ‘without sufficient warning to allow safe evasive action when driving’ and disabling is defined as ‘unable to continue safely with the activity being performed’.

Stroke, transient ischaemic attack (TIA) and cerebral venous thrombosis – including amaurosis fugax and retinal artery occlusion

For Group 2 bus and lorry drivers, the guidance is the same whether concerning stroke, or single or multiple transient ischaemic attack (TIA).

Cerebral amyloid angiopathy-related transient focal neurologic episodes (previously termed “amyloid spells”)

Cerebral amyloid angiopathy (CAA)-related transient focal neurological episodes (TFNE) are usually recurrent, stereotyped attacks of unilateral spreading symptoms including paraesthesia, numbness, or weakness (alone or in combination), lasting less than 10 minutes. In most cases, TFNE are associated with either convexity sub-arachnoid haemorrhage (cSAH), cortical superficial siderosis (the chronic form of cSAH), or both.CAA related TFNE

See also the section on non-aneurysmal subararchnoid haemorrhage (including perimesencephalic) (https://www.gov.uk/guidance/neurological-disorders-assessing-fitness-to-drive#subarachnoid-haemorrhage).

Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS)

Visual inattention

Carotid artery stenosis

Acute encephalitic illness and meningitis - including limbic encephalitis associated with seizures

Transient global amnesia

Arachnoid cysts

Colloid cysts

Pituitary tumour including craniopharyngioma

Brain tumours

The standards will apply to first occurrence, recurrence and progression.

Section 1 classifies the different tumour types into 4 groups:
- very low risk primary brain tumours
- low risk primary brain tumours
- high risk primary brain tumours
- metastatic cerebral disease, primary and secondary lymphoma, and non-Central Nervous System (CNS) tumours invading intracranially and breaching the dura
The risk refers to seizure risk and/or risk of recurrence and also the risk of deterioration.

Section 2 then provides the medical standards of fitness to drive for Group 1 licensing (cars and motorcycles) and Group 2 licensing (lorries and buses) for each of these 4 groups.

The standards for acoustic neuroma/schwannoma, pituitary tumours and arachnoid and colloid cysts are detailed elsewhere.

In individuals where there are mixed grades of tumours and/or two types of therapy, the higher standard (longer time off driving) will apply.

When a tumour or its treatment is being monitored with imaging, this should usually demonstrate an absence of progression or deterioration.

Pineal tumours have been categorised as infratentorial in the classification table. DVLA acknowledges these tumours are not anatomically considered to be infratentorial. It was concluded this classification best reflected the risk of seizures and potential effect on driving of this tumour type.

If the tumour has been associated with seizures, please refer to the seizure guidelines within Assessing Fitness to Drive: A guide for medical professionals, which will apply in addition to the standards listed in this document. A brain tumour is generally considered to be an underlying risk factor that increases risk of further seizures, and a longer time off driving will be applied. Licensing is dependent on there being no residual impairment likely to affect safe driving, for example, debarring hemianopia or cognitive impairment.

Any brain tumours in childhood (age 16 or before) must be notified to DVLA. If the tumour is successfully treated with no recurrence, a full-term (until 70) licence is usually issued.

Section 1 – Classification of tumour

Section 2 – Medical standards of fitness to drive

Very low risk brain tumours

Low risk brain tumours

High risk brain tumours

Metastatic brain disease, CNS Lymphoma and non-CNS tumours invading intracranially and breaching the dura – these standards apply to any cerebral recurrences as well as first occurrence

Acoustic neuroma/schwannoma

Brain biopsy

Traumatic brain injury

Subdural haematoma

With any procedure, if another one is also undertaken (for example a ventriculoperitoneal shunt, and a craniotomy for a haematoma), the standards for that procedure also apply, and may take precedence.

Isolated subdural haematoma without traumatic brain injury

Subarachnoid haemorrhage

Perimesencephalic (non-aneurysmal) haemorrhage*

*See also the section on CAA-related TFNE (https://www.gov.uk/guidance/neurological-disorders-assessing-fitness-to-drive#cerebral-amyloid-angiopathy-related-transient-focal-neurologic-episodes-previously-termed-amyloid-spells).

Intradural (intracranial) aneurysm – truly incidental finding without haemorrhage or local symptoms

In situations whereby multiple aneurysms have been identified, fitness to drive should be assessed against the aneurysm associated with the greatest risk.

Symptomatic intradural (intracranial) aneurysm (present with haemorrhage or other symptoms related to the aneurysm)

In situations whereby multiple aneurysms have been identified, fitness to drive should be assessed against the aneurysm associated with the greatest risk.

Haemorrhage from non-middle cerebral artery aneurysm

Haemorrhage from middle cerebral artery aneurysm

Extradural (intracranial) aneurysm (cavernous sinus aneurysm)

Other extra-dural aneurysms (for example, spinal aneurysms)

Arteriovenous malformation (AVM)

With any of the procedures, if another is also undertaken (for example, a ventriculoperitoneal shunt or a craniotomy for a haematoma) the standards for that procedure also apply and may take precedence.

Supratentorial

Infratentorial AVM

Intracranial haemorrhage due to infratentorial AVM

Incidental finding of infratentorial AVM

Dural arteriovenous fistula

Not associated with haemorrhage or neurological deficit.

Not associated with haemorrhage or neurological deficit.

Associated with haemorrhage or neurological deficit.

Cavernous malformation

Cavernomas are also known as cavernous malformations, cavernous angiomas, or cavernous haemangiomas. They are all surrounded by haemosiderin on brain MRI, but this does not necessarily imply that they have ‘bled’ in the past. The risk of events that might affect driving differs according to cavernoma location (brainstem vs. other locations) and symptoms attributable to the cavernoma (stroke vs. epileptic seizure vs. no symptoms).

A person’s age, the number of cavernomas, and the size of the cavernoma do not seem to affect these risks. With multiple cavernomas, licensing restrictions differ according to cavernoma location, symptoms, or treatment. The most restrictive guidance will apply.

Supratentorial cavernoma

Infratentorial cavernoma

Intracerebral abscess/subdural empyema

Cranioplasty

Chiari malformation

No treatment required

Surgical treatment/foramen magnum decompression

Hydrocephalus

Intraventricular shunt or extraventricular drain – insertion or revision of upper end of shunt or drain

Neuroendoscopic procedures – for example, third ventriculostomy

Intracranial pressure monitoring device – inserted by burr hole surgery

Functional neurosurgical techniques

Deep brain stimulation (DBS) for movement disorder or pain

Microvascular decompression

Invasive thalamotomy

Non-invasive thalamotomy (including MRI ultrasound or stereotactic surgery)