OBJECTIVES: To evaluate the availability and consistency of commercial driving eligibility criteria for patients with seizures. METHODS: We systematically evaluated commercial driver's license regulations for patients with epilepsy, first acute symptomatic seizure and first unprovoked seizure in different countries. Government driving authority websites and published guidelines were accessed and if not available, local neurologists were contacted. RESULTS: Information on commercial driving eligibility was available for 112 countries: 85 (76 %) via government websites or published guidelines and 27 (24 %) via direct contact with local neurologists. For epilepsy, 85 countries had clear guidelines: 42 countries requiring a seizure-free period of between 5 and 10 years, 43 applying a lifetime ban. Twenty-seven responding countries had no guidelines. For first acute symptomatic seizure (information available for 101 countries), 33 countries either required an individualised assessment or specified a seizure-free period ranging between 6 months and 10 years, 38 had a lifetime ban and 30 had no guidelines. For first unprovoked seizure (information available for 103 countries) 35 countries required seizure freedom for 1 to 10 years, 38 enforced a lifetime ban and 30 had no guidelines. There was considerable variation in the requirements for MRI, EEG, treatment with anti-seizure medication, and/or neurologist input. CONCLUSIONS: A marked lack of uniformity in commercial vehicle license guidelines exists for patients with seizures, likely in part reflecting the paucity of long-term data to inform evidence-based policy.