“I have a patient that just asked me if he could NOT have the Seizure waiver/exemption checked on his card as he had his neurologist sign off on everything.
He states he has applied for the waiver and submitted everything for the waiver but would like to have a clean card as his seizures have been under control for 10+ years. His last seizure was in 2016. He is on Keppra 500 mg QD.
His diagnosis is Complex partial epilepsy, idiopathic controlled.
He has a letter from his neurologist stating that he is cleared to have his DOT card as he has been stable for many years and there are no concerns.
So, I don’t like his diagnosis but the fact that he has been so well controlled for so long what are your thoughts? Do we just say that we have to stay with the exemption? Once an exemption has been put in place how does it get taken off?”
Thank you for your question regarding commercial vehicle drivers with seizure disorders.
The Federal Department of Transportation’s physical standards for commercial drivers as they pertain to epilepsy and seizure disorders appear in 49 CFR 391.41(b)(8):
“A person is physically qualified to drive a commercial motor vehicle if that person —Has 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.”
Based on the language of CFR 391.41 and the recommendations from a Medical Review Board expert panel convened in 2007, FMCSA has interpreted this standard to mean that any person who has had a single seizure or a diagnosis of epilepsy and continues to take anti-epilepsy drugs (AED) is not qualified for certification as a commercial driver.
Patients with a single seizure or epilepsy can qualify for a CMV license if they have been off medication and seizure-free for five years in the case of the single seizure or 10 years if they have been diagnosed with epilepsy. According to the 2024 CME Handbook, this option is still available. See the table below under “Previous Standard.”
While a seizure exception has existed, a standard framework known as the Federal Seizure Exemption was introduced more recently. This program allows drivers who are seizure-free but remain on anti-epilepsy drugs to apply for a federal seizure exemption through FMCSA. The requirements of this program are listed in the table below.
Now, to answer your question:
Can a driver with the diagnosis of idiopathic epilepsy/seizure disorder who is seizure-free for an extended period of time but remains on anti-seizure medication be certified without a seizure exemption?
No.
Any patient with a known seizure disorder who remains on medication must obtain a Federal Seizure Exemption to qualify for a commercial driver certificate. Without the federal seizure exemption, there is no pathway to mature out of the program while still taking medication.
Max Lebow, MD, FACOEM, FACEP
