Drugs, driving and traffic safety in multiple sclerosis

  • Sylvia Kotterba


Up to 65 % of patients with multiple sclerosis (MS) show sensory-motor deficits and cognitive impairment which influence activities of daily life and driving skills. Although there is certain evidence of driving difficulties among people with MS, only few studies have focused on this problem. Governmental regulations are based on little evidence.

All studies, mostly based on a small number of participants, have revealed that not physical disabilities but cognitive impairment has a strong impact on driving skills., Questionnaires, computer- based neuropsychological tests, and driving simulators have been used in order to assess driving skills. On-road tests have been applied, especially in cases of ambiguous test results.

Certain drugs recommended for different symptoms (spasticity, paroxysmal symptoms) are apt to cause fatigue and sleepiness. Disease modifying therapy (especially intramuscular interferon ß-1a) has demonstrated a beneficial effect on neuropsychological performance that can also improve driving abilities.


Multiple Sclerosis Driving Skill KDYH EHHQ ZHUH IRXQG Driving Simulator Skill 
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  1. 1.
    Rao SM, Leo GJ, Bernardin L, Unverzagt F (1991) Cognitive dysfunction in multiple sclerosis: I. frequency, patterns, and prediction. Neurology 41: 685–691PubMedGoogle Scholar
  2. 2.
    Beatty W, Goodkin DE, Hertsgaard D, Monson N (1990) Clinical and demographic predictors of cognitive impairment in multiple sclerosis: do diagnostic type, disease duration, and disability matter? Arch Neurol 47: 305–308PubMedGoogle Scholar
  3. 3.
    Galski T, Bruno RL, Ehle HAT (1992) Driving after cerebral damage: a model with implications for evaluation. Am J Occup Ther 46: 324–332PubMedGoogle Scholar
  4. 4.
    Haikonen S et al. (1998) Neuropsychological correlates of duration of glances at secondary tasks while driving. Appl Neuropsychol 5: 24–32PubMedCrossRefGoogle Scholar
  5. 5.
    Schultheis MT, Garay E, DeLuca J (2001) The influence of cognitive impairment on driving performance in multiple sclerosis. Neurology 56: 1089–1094PubMedGoogle Scholar
  6. 6.
    Orth M, Leidag M, Kotterba S, Widdig W, de Zeeuw J, Walther JW, Duchna HW, Schäfer D, Schläfke ME, Malin JP et al. (2002) Abschätzung des Unfallrisikos bei obstruktivem Schlafapnoe-Syndrom (OSAS) durch Fahrsimulation. Pneumologie 56: 13–18PubMedCrossRefGoogle Scholar
  7. 7.
    Orth M, Duchna HW, Leidag M, Widdig W, Rasche K, Bauer TT, Walther JW, de Zeeuw J, Malin JP, Schultze-Werninghaus et al. (2005) Driving simulator and neuropsychological testing in OSAS before and under CPAP Therapy. Eur Respir J 26: 898–903PubMedCrossRefGoogle Scholar
  8. 8.
    Orth M, Herting A, Duchna HW, Walther JW, de Zeeuw J, Bauer TT, Schultze-Werninghaus G, Kotterba S (2005) Fahrsimulatoruntersuchung bei Patienten mit obstruktivem Schlafapnoe-Syndrom: Konsequenzen für die Beurteilung der Fahrtüchtigkeit? Dtsch Med Wochenschr 130: 2555–2560PubMedCrossRefGoogle Scholar
  9. 9.
    Kotterba S, Müller N, Leidag M, Widdig W, Rasche K, Malin JP, Schultze-Werninghaus, M. Orth (2004) Comparison of driving simulator performance and neuropsychological testing in Narcolepsy. Clinical Neurology and Neurosurgery 106: 275–279PubMedCrossRefGoogle Scholar
  10. 10.
    Kotterba S, Widdig W, Brylak St, Orth M (2005) Driving after cerebral ischemia-a driving simulator investigation. Wien. Med. Woch. 155/15–16: 348–353CrossRefGoogle Scholar
  11. 11.
    Lings S (2002) Driving accident frequency increased in patients with multiple sclerosis. Act Neurol Scand 105: 169–173CrossRefGoogle Scholar
  12. 12.
    Knecht J (1977) The multiple sclerosis patient as a driver. Schweizerische Medizinische Wochenschrift 107: 373–378PubMedGoogle Scholar
  13. 13.
    Schanke AK, Grimsmo J, Sundet K (1995) Multiple sclerosis and prerequisites for driver’s license. A retrospective study of 33 patients with multiple sclerosis assessed at Sunnaas hospital. Tidsskrift for Den Norske Laegeforening 115: 1349–1352PubMedGoogle Scholar
  14. 14.
    Lincoln NB, Radford KA (2008) Cognitive abilities as predictors of safety to drive in people with multiple sclerosis. Mult Scler 14: 123–128PubMedCrossRefGoogle Scholar
  15. 15.
    Begutachtungs-Leitlinien zur Kraftfahrereignung. Berichte der Bundesanstalt für Straßenwesen. Heft M115, 2000Google Scholar
  16. 16.
    Gronwall D (1977) Paced auditory serial addition task: a measure of recovery from concussion. Percept Mot Skills 44: 363–73Google Scholar
  17. 17.
    Kotterba S, Orth M, Eren E, Fangerau T, Sindern E (2003) Assessment of driving performance in patients with relapsing-remitting multiple sclerosis by a driving simulator. Eur Neurol 50: 160–164PubMedCrossRefGoogle Scholar
  18. 18.
    Whitaker JN, McFarland HF, Rudge P, Reingold SC (1995) Outcomes assessment in multiple sclerosis clinical trials: a critical analysis. Multiple Sclerosis 1: 37–47PubMedGoogle Scholar
  19. 19.
    Rudick R, Antel J, Confavreux C, Cutter G et al (1997) Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment task Force. Ann Neurol 42: 379–82PubMedCrossRefGoogle Scholar
  20. 20.
    Chipchase SY, Lincoln NB, Radford KA (2003) A survey of the effects of fatigue on driving in people with multiple sclerosis. Disabil Rehabil 25: 712–723PubMedCrossRefGoogle Scholar
  21. 21.
    Stueckle KF, Sindern E, Kotterba S (2005) Assessment of driving performance in patients with relapsing-remitting multiple sclerosis (rrms) during 24 month therapy with interferon Beta-1 a (AVONEX) Multiple Sclerosis 11: S78–S79 Suppl. 1Google Scholar
  22. 22.
    Shanke AK, Grimsmo J, Sundet K (1995) Multiple Sclerosis and prerequisites for driver’s licence. Tidsskr Nor LCEgeforen 115: 1349–1352Google Scholar
  23. 23.
    Schultheis MT, Garay E, Millis SR, DeLuca J (2002) Motor vehicle crashes and violations among drivers with multiple sclerosis. Arch Phys Med Rehabil 83: 1175–1178PubMedCrossRefGoogle Scholar
  24. 24.
    Orth M, Rasche K, Malin J.-P., Schultze-Werninghaus G, Kotterba S (2003) Unfälle durch Müdigkeit-Prädiktionsmöglichkeit durch neurophysio-/psychologische Testung und Fahrsimulatoruntersuchung. Biomed Technik 48: 55–61CrossRefGoogle Scholar
  25. 25.
    George CF, Boudreau AC, Smiley A (1996) Comparison of simulated driving performance in narcolepsy and sleep apnea patients. Sleep 19: 711–717PubMedGoogle Scholar
  26. 26.
    Krupp LB, Rizvi SA (2002) Symptomatic therapy for under-recognized manifestations of multiple sclerosis. Neurology 58: S32–S39PubMedGoogle Scholar
  27. 27.
    Fischer JS, Priore RL, Jacobs LD, Cooklair DL, Rudnick RA, Herndon RM et al. (2000) Neuropsychological effects of interferon ß-1a in relapsing multiple sclerosis. Ann Neurol 48: 885–892PubMedCrossRefGoogle Scholar
  28. 28.
    Cohen JA, Sutter GR, Fischer JS, Goodman AD et al. (2002) Benefit of interferon ß-1a on MSFC progression in secondary progressive MS. Neurology 59: 679–687PubMedGoogle Scholar
  29. 29.
    Gold St, Schulz H, Mönch A, Schulz KH, Heesen Ch (2003) Cognitive impairment in multiple sclerosis does not affect reliability and validity of self-report health measures. Multiple Sclerosis 9: 404–410PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • Sylvia Kotterba
    • 1
  1. 1.Department of NeurologyAmmerland-Klinik GmbHWesterstedeGermany

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