Movement disorders and their impact in driving
Movement disorders can be divided into two major groups:
They are characterized by poor movements, weariness in carrying them out, slowness and rigidity, at the same time with a great muscle tension that exerts a strong resistance to passive movement.
Idiopathic Parkinson’s disease is characterized by akinesia, bradykinesia, rigidity, tremor at rest that increases with anxiety and disappears with sleep, and postural instability.The slowness of movements affects the finest and progressively interfere with all daily life activities, including driving.
Patients eventually become still, without barely blinking, and are not able to read or write. The rigidity affects more the neck and the limbs.They cannot adopt an upright position when walking and suffer equilibrium disorders and frequent falls.Depressive symptoms are almost always present and dementia is frequently established.
Treatment with L-Dopa is symptomatic and has side effects that must be considered, such as digestive intolerance, orthostatic hypotension, cardiac arrhythmia that can be serious, and psychiatric disorders.
The adverse effects of central origin related to treatment with L-Dopa appear around two years and are characterized by motor fluctuations and dyskinesia.
- In any of the above situations, the patient cannot drive.
- Therefore, these patients show symptoms due to the disease itself, and some more important due to the treatment required, that prevent them from driving.
- The patient should know the side effects of the treatment to maximize their precautions when driving and, if they notice any symptom, they must stop driving and notify their physician.
- The specialist will assess the ability of the patient to drive, given the outcome of the disease and the tolerance to the treatment prescribed.
Parkinsonism can result of infections, toxic substances, drugs such as neuroleptics, reserpine, alpha-methyldopa, lithium, amiodarone, phenelzine, meperidine, amphotericin B, cephaloridine, diltiazem, ethanol, procaine, tricyclic antidepressants and valproate.Also, due to cerebrovascular diseases, metabolic disorders of calcium, brain injuries and amyotrophic diseases of the central nervous system, amongst others.
Physiological tremor is involuntary and can increase in situations of anxiety.
Essential tremor is often familial and affects the hands, head, neck, legs and speech. In serious cases, it is completely disabling for driving.
Treatment with beta-blockers is compulsory in these cases and the possibility of driving will depend on the therapeutic result.
Senile tremor starts above 65 years of ages and is sometimes associated with neurological diseases of the central nervous system.
Myoclonus can be an epileptic manifestation, and often appear in neurological diseases or degenerative neurological disorders.
Chorea is an unpredictable, involuntary, and irregular movement affecting several body areas, and can be provoked by drugs such as neuroleptics.
- Sydenham’s chorea can have a sudden or insidious onset, and be unilateral or bilateral.
- Chorea associated with disseminated lupus erythematosus is hemicorporal although, in some cases, it can be generalized, and its outcome is variable
- Huntington’s chorea is hereditary and is characterized by dementia, chorea, and behavioral disorders, with a progressive and disabling outcome.
Ballism is an irregular, violent movement, of great range, that affects the proximal musculature of the limbs, and is usually hemicorporal. The leading cause is stroke.
Dystonias are slow, sustained movements causing postural disorders of idiopathic origin, such as primary focal dystonias including blepharospasm, spasmodic torticollis and dystonia of limbs.
The treatment is difficult, with limited results.
Secondary dystonias are usually due to drugs including metoclopramide, levodopa and direct dopaminergic agonists; sometimes, dystonia is a symptom of neurological diseases.
Tics, if severe, can interfere with safety while driving and, therefore, medical therapy should be attempted with benzodiazepines, clonidine, neuroleptics, etc.
- Patients with clear tremor cannot drive.
- The physician will indicate, considering treatment response, if the patient can drive.
- In states of anxiety, the relaxing treatment, by reducing tremor, will allow for driving, but warning that the drug can cause drowsiness, so that the patient maximizes precautions when driving.
- It is important that physicians warn the patients about their condition, about their possibility to develop parkinsonism, and about the risk of its symptoms when driving.
- We should advise against driving in every patient with parkinsonism, and at the same time, immediately discontinue the drugs that may have caused it.
- Until the disease or metabolic disorder leading to the clinical condition of parkinsonism are not controlled, the patient cannot drive.
- The physician will report of the satisfactory outcome of patient, without symptoms and without recurrences, when he considers advisable that the patient drives.
- The patient should contact his physician in case of any doubt and if the presence of symptoms is confirmed, even if starting, to advise against driving until the clinical symptoms subside.
- Driving is advised against for the possible loss of control of the car.
- If the causal disease is treated, and after a reasonable observation period, the patient is asymptomatic, the physician will report if the patient can drive without restrictions.
- Chorea in its multiple varieties prevents from driving.
- We should warn the patient treated with major tranquilizers of the possibility for developing a clinical condition with chorea as adverse reaction, so that if it happens, he immediately discontinues the treatment and does not drive until he is assessed and treated without risk of recurrence.
- The specialist’s report will allow for assessing if a patient can drive safely.
- Ballism: the patient cannot drive until complete resolution of the clinical condition without sequelae and always with specialist’s report.
- Dystonias prevent from performing the necessary movements when driving, so it is not recommended.
- In secondary dystonias, if the etiological treatment is satisfactory, the symptoms will disappear and the patient may drive, with a specialist’s report in this regard.
- Complex tics limit driving with the risk of losing the control of the car.
- The tic can improve with drugs, but the patient must warned of the side effects frequently caused, including drowsiness and reduced reflexes.