Seizure Disorders and Commercial Driver Certification: FMCSA Guidelines

Seizure disorders are among the most clearly defined disqualifying conditions in DOT physical examinations. Understanding the FMCSA guidelines for drivers with a history of seizures or epilepsy is critical for making correct certification decisions and is a frequently tested topic on the NRCME exam.

The General Rule: Seizures Are Disqualifying

Under FMCSA regulations (49 CFR 391.41), a driver is physically qualified to operate a CMV only if they have “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 CMV.”

This means any history of epilepsy or unprovoked seizures is generally disqualifying for commercial driving. The concern is clear: a seizure while operating a large commercial vehicle poses an extreme safety risk to the driver, passengers, and the public.

Seizure-Free Period Requirements

A driver with a history of seizures may be considered for certification if they have been seizure-free for a significant period and meet additional criteria. The advisory criteria from FMCSA indicate:

• Epilepsy / recurrent seizures: The driver should be seizure-free and off anti-seizure medication for at least 8 years
• Single unprovoked seizure: The driver should be seizure-free and off medication for at least 8 years (some guidance suggests a shorter period may be acceptable with neurologist clearance)
• Provoked seizure (caused by a known, removable trigger such as medication reaction or acute illness): Evaluated on a case-by-case basis with supporting documentation

Anti-Seizure Medications

Current use of anti-seizure medications is generally disqualifying, regardless of how long the driver has been seizure-free while on medication. The reasoning is that the medication is controlling the seizures, and stopping it could lead to recurrence. A driver taking anti-seizure medication is not considered to have a resolved condition.

Exceptions may exist for medications prescribed for conditions other than seizures (e.g., gabapentin for pain), but this requires careful evaluation and documentation.

What Documentation to Require

When a driver discloses a history of seizures or epilepsy, the medical examiner should request:

• Neurologist evaluation and clearance — Including confirmation of the diagnosis, seizure history, and current status
• Medication history — When anti-seizure medication was started and stopped
• Seizure-free period documentation — Evidence supporting the claimed duration without seizures
• EEG or other testing results if available
• Neurologist’s opinion on driving safety

Related Conditions

Several related conditions require similar evaluation:

• Febrile seizures in childhood: Generally not disqualifying if limited to childhood and the driver has had no seizures since
• Post-surgical seizures: Evaluated based on the underlying cause and current seizure-free status
• Syncope (fainting): While not a seizure, unexplained syncope can also be disqualifying as it involves loss of consciousness. The cause must be identified and treated.
• Post-stroke seizures: Evaluated as part of the overall stroke recovery assessment

NRCME Exam Tips

Seizure questions on the NRCME exam typically test whether you know the seizure-free period (8 years), the requirement to be off anti-seizure medication, the need for neurologist clearance, and the distinction between provoked and unprovoked seizures. The questions are usually straightforward if you know the guidelines.

Our NRCME practice tests covers neurological conditions including seizure scenarios that mirror what you’ll see on the exam.