Brain tumors and fitness to drive: A review and multi-disciplinary approach

Patients with brain tumors and their families often inquire about driving safety. Currently, there is no consensus regarding fitness-to-drive (FTD) for patients with central nervous system tumors. Our paper aims to provide a multi-disciplinary perspective to address this issue.

We performed a literature review for brain tumors and driving. Additionally, we solicited input from experts in tumor-related epilepsy, ophthalmology, neuropsychology, occupational therapy, and driving simulators.

We qualitatively analyzed 14 published articles. FTD determination varies internationally and regionally in most developed nations. Significant motor weakness and major cognitive impairment clearly prevent patients from driving. There are specialized tests for motor, vision, and cognitive correlates important to driving, but driving simulators and on-the-road tests provide the most comprehensive assessments. FTD for patients with seizures is dependent on region-specific laws that take into account the duration of seizure-free intervals and history of motor vehicular crashes.

We recommend a symptom-based approach that highlights the importance of interdisciplinary assessment to ensure that brain tumor patients have the minimum operational skills required to drive. It is crucial to document seizure control, visual acuity impairment, and visual field deficits because these factors usually become the default basis in practice to determine if driving privileges can be maintained. Appropriately, timed assessment of cognitive function may provide pertinent information to determine FTD. Formalized testing with practical driving evaluation may eventually be necessary in patients who have hemiparesis, hemiplegia, hemineglect, homonymous visual field loss, or any form of cognitive dysfunction to determine FTD.