Multiple sclerosis (MS) is a chronic disease that affects your brain, spinal cord, and optic nerves. It occurs when your immune system attacks a fatty substance around your nerves called myelin, damaging your nerves’ ability to transmit electrical signals.

Many people with MS can drive normally, but others may need adaptive equipment. Some people with multiple sclerosis may have to stop driving altogether for safety concerns. The best way to find out if it’s safe for you to drive is to get evaluated by a driving rehabilitation specialist.

In this article, we examine some of the ways MS can affect driving, how to get evaluated, and what modifications can be made to your car.

Multiple sclerosis can affect your reflexes, strength, and mobility over time, according to the National Institute of Neurological Disorders and Stroke. If these changes become significant enough, it may be difficult or impossible for you to drive safely. A 2021 study found drivers with MS may have an increased risk of driving accidents.

Being diagnosed with MS doesn’t legally prevent you from driving. Regulations vary by state, but most require you to disclose any conditions that may affect your ability to drive, including MS.

The course of MS is unpredictable. Some people only ever experience mild symptoms, while others develop severe disabilities. Because of this variation, deciding someone’s fitness for driving with MS is an individualized process that involves evaluating your vision, cognition, and physical mobility.

Vision problems

Many people with MS develop vision problems that can affect driving. One common first symptom of MS is optic neuritis.

According to 2020 research, optic neuritis can cause the following:

Other symptoms

People with MS commonly develop cognitive, motor, or other general health impairments that affect driving quality.

MS-related symptoms that can impact driving include:

Physical symptoms can cause difficulty operating your car’s gas and brake pedals, turning the wheel, or using the gearshift. Cognitive symptoms can cause slow reaction time, cause you to become lost, or make it harder to regulate emotions.

Certain MS medications may also have side effects, like drowsiness or poor concentration. These side effects may contribute to driving impairment.

Sometimes, driving may be deemed unsafe during MS flare-ups but safe during other periods. Flare-ups are periods when your symptoms are particularly bad. MS symptoms often get worse when you’re stressed or sick.

If you or your loved ones are concerned about your driving, you may benefit from a driving evaluation. This will determine your driving fitness, which refers to your ability to fulfill the needs of being behind the wheel.

Some of the signs that it may be time for an evaluation are:

  • almost getting into an accident
  • having a recent accident
  • receiving traffic tickets
  • unwillingness of friends or family to be passengers while you’re driving due to safety concerns

You can get evaluated at driving rehabilitation clinics often found in medical centers. The evaluation is performed by a special type of occupational therapist called a driver rehabilitation specialist. It usually lasts about 2 hours, according to the National Multiple Sclerosis Society.

You can find a specialist in your area through the Association for Driver Rehabilitation Specialists (ADED) website.

Being cleared to drive by your doctor

It’s important you stay in close communication with your doctor about any changes in symptoms or their severity. In many states, a report from your healthcare professional is required to medically clear you to drive if you have a health condition that can cause driving impairment.

Reach out to your local DMV to get the most accurate information about what documents you need to drive with MS. Here’s a master list of DMVs by state.

What to expect

Part of the assessment will be office-based, and part will be behind-the-wheel. Here’s what to expect, according to the National Multiple Sclerosis Society’s 2020 driving brochure.

In the office, your driver rehabilitation specialist will review your medical and driving history and consider how MS has affected your daily life. They’ll ask you if you’ve had any specific driving problems, received any tickets, or have been in any accidents.

The specialist will also test your:

  • strength and range of movement
  • coordination
  • sensation and movement speed
  • vision
  • cognitive performance

If you do well on these tests, you’ll move on to a road test. The road test will generally start in an area of low traffic and progress to an area of high traffic.

A road test for driving fitness will assess your:

  • ability to get in and out of the vehicle
  • safety awareness
  • ability to change lanes and stay in a lane
  • ability to multi-task
  • judgment before turning
  • attention to the road
  • reaction time
  • ability to follow traffic laws
  • ability to stow assistive devices like a wheelchair, walker, or cane

Simulated driving evaluation

Researchers continue to examine the potential benefits of virtual reality simulation for evaluating the driving ability of people with MS.

A small 2018 study found that people with MS had trouble maintaining the trajectory and speed of a simulated vehicle. These impairments weren’t revealed by a traditional cognitive test.

However, a 2019 review of many studies found insufficient evidence that simulators can accurately predict driving performance at this time.

Many pieces of equipment can be added to your car to make driving safer or more comfortable.

According to the ADED, options include:

  • hand controls that let you operate the gas and break with your hands instead of by foot
  • a spinner knob that makes it easier to turn the wheel
  • easy to grip handy bars that attach to your car door
  • specialized seats to make it easier to get in and out of your vehicle
  • special mirrors that help with vision loss, such as larger side mirrors or a multi-panel rear-view mirror
  • tie-downs to secure mobility devices
  • lifts for stowing wheelchairs and other assistive devices
  • a handicap placard to use parking spaces and zones reserved for disabled people, which you can apply for through your local DMV

Your driver rehabilitation specialist can help recommend specific equipment and teach you how to use it. Once you can show that you can use all the equipment safely, you’ll need to complete a road test through your local DMV.

If you pass your road test, your driver’s license will indicate that you’re required to drive with special equipment.

The National Highway Traffic Safety Administration (NHTSA) provides the following general tips regarding adapting vehicles:

  • Costs can be high and vary depending on your disability. The NHTSA says adaptive equipment on a new car may cost anywhere from $20,000 to $80,000.
  • Reach out to nonprofit organizations, or ask your local state government office to direct you. Some nonprofits have resources to help pay for adaptive technologies.
  • Many states waive sales tax on adaptive equipment for vehicles, and some may be tax deductible.

Check out the NHTSA’s guide on adapting motor vehicles for people with disabilities.

Driving can be very important for a person’s independence, both physically and psychologically. This is especially true if you have a disability or few options for transportation.

If you find out you’re not able to drive anymore, it’s natural to feel grief, loss, or frustration. It’s important you get support during this time to help you cope and process. Seek emotional support from loved ones, and consider connecting with a therapist to guide you through this difficult time.

Public transport may be a feasible alternative to driving, depending on where you live. There’s also paratransit, a van-and-taxi program for people unable to use standard public transport because of disability. The Americans with Disabilities Act (ADA) has required all public transport agencies to offer paratransit options since 1990.

Other transportation options you can consider are:

  • planning rides with friends or family members
  • using taxis or ride-share apps
  • calling on volunteer drivers from local organizations

You may also want to check in with your state agency responsible for making sure people with disabilities have transportation.

Getting more information

The National Aging and Disability Transportation Center (NADTC) is dedicated to helping older people and those with disabilities access transit options. They’re funded by the Federal Transit Administration. The NADTC can help you figure out travel logistics and understand the resources in your area.

You can call NADTC at (866) 983-3222 or email contact@nadtc.org.

MS symptoms vary significantly between people. Many people with MS can continue driving after onset, but some experience disabilities that limit their ability to drive safely or comfortably. Even if it’s safe for you to drive now, it may not be safe in the future.

MS-related vision problems are a major factor impairing driving ability. In some people with MS, cognitive and motor symptoms can also slow reaction time, lead to disorientation, and contribute to accidents.

Driving is a significant source of independence for people in general, especially those with disabilities. But ultimately, safety comes first. Getting thoroughly evaluated for driving fitness when you have MS protects you and those around you.

Reach out to your local DMV for information on what documents you need, and work with your doctor to determine whether you’re fit to drive. The best way to know if it’s safe for you to drive is to get an evaluation from a driving rehab specialist. A specialist can also recommend adaptive equipment for your vehicle to make driving safer or easier.