Driving restrictions for patients with reflex syncope

Reflex syncope is the most common form of syncope that occurs while driving. The 2014 revision of Japanese Road Traffic Laws placed stricter driving restrictions, along with some associated legal penalties, on individuals with recurrent syncope. “Recurrent syncope” is defined as the occurrence of more than two episodes of syncope over a period of 5 years. No restrictions are recommended for private drivers unless they experience syncope without a reliable prodrome while driving or sitting. For commercial drivers, a driving restriction is recommended unless the efficacy of treatment can be confirmed. The “risk of harm” (RH) to other road users appears to be particularly high when commercial driving is involved. The RH formula is calculated using the time of driving, the type of vehicle driven, the risk of sudden cardiac incapacitation, and the probability of a fatal or injury-producing accident. Reducing the driving time or driving a lighter vehicle can reduce the RH. Physicians should talk to their patients about driving and advise their high-risk patients to refrain from driving.