Brain Seizure Activity and Diving

[Gene_Hobbs]

Here is another good starting point:

Acott, C. Neurological injury and a return to recreational diving. SPUMS 1996 Volume 26 Number 1. RRR ID: 6270

A return to diving should depend upon a negative response to all of the following questions: a) Will the continued diving make the condition of the diver worse? b) Will the condition of the diver compromise the diver’s or buddy’s safety in the water? c) Will the condition of the diver predispose to or aggravate a diving illness?

Traumatic brain injury will affect fitness for diving and consequently considerable information about the nature of the injury is necessary. Details of localising signs, the period of unconsciousness, the duration of post traumatic amnesia, the presence of intracranial bleeding or of a penetrating injury or skull fracture and the likelihood of future seizures must be known. A study of closed head trauma in 1,000 patients reported the lowest incidence of traumatic epilepsy were in an uncomplicated head injury with post traumatic amnesia of less than 1 hour.35 A history of a loss of consciousness of greater than 10 minutes, the presence of localising signs, an amnesic period of greater than one hour, the presence of intracranial bleeding, any skull fracture other than an uncomplicated linear one and of a penetrating injury would disqualify from future diving because of the risk of post traumatic epilepsy. However, a five year seizure free period without medication and after a meticulous history and examination may allow a diver to return to recreational diving if one uses idiopathic epilepsy as a guide,36 although some may consider this too conservative because 80% of post traumatic epilepsy will present within 2 years of injury.37 My view is that any risk of an underwater convulsion is a contraindication to further recreational diving.

Another reference (NOTE - large file):
Vorosmarti J, Linaweaver PG (eds). Fitness to Dive. 34th Undersea and Hyperbaric Medical Society Workshop. UHMS Publication Number 70(WS-WD)5-1-87. Bethesda: Undersea and Hyperbaric Medical Society; 1987; 116 pages. RRR ID: 4249

Hope these help.

 

[fisherdvm]

UKSDMC medical standards- epilepsy


UK SPORT DIVING MEDICAL COMMITTEE



Neurological- epilepsy
An epileptic attack occurring underwater while using conventional scuba equipment is usually a fatal event, since the mouthpiece is likely to be lost and large quantities of water inhaled during the clonic phase of the fit. It is therefore imperative that no epileptic should dive if there is any serious possibility of an attack occurring underwater.

A second factor which has to be considered is the nature of the drugs used to control epilepsy, which are all, to some degree, sedative in nature and would thus exacerbate nitrogen narcosis or cause it to come on at an unexpectedly shallow depth. For this reason, it is not considered safe for any epileptic to dive if he/she is currently taking any anti-epileptic medication.

Since hyperbaric oxygen is known to provoke convulsions in normal individuals, it was formerly considered that epileptics would be at increased risk when exposed to the raised partial pressure of oxygen in compressed air breathed at depth. However, it is now known that the mechanism of the attack is different, and epileptics are not more susceptible to convulse under pressure. Thus, this factor can be disregarded.

The relapse rate in epileptics who are taken off medication decreases exponentially, with the majority of those relapsing doing so within the first eighteen months of ceasing treatment and the rate of relapse becoming insignificant after three years (1,2).

The suggested requirements for an epileptic to be permitted to dive are therefore set at five years free from fits and off medication. Where the fits were exclusively nocturnal, this can be reduced to three years.

A past history of petit mal should not disqualify, provided that no attacks have occurred for five years and that the condition has not progressed to epilepsy. Pyrexial convulsions in childhood may be disregarded if not followed by epilepsy.

Post traumatic epilepsy: see medical standard on Head Injury and Diving.

References:

1. Anonymous. Should epileptics scuba dive? JAMA 1985. 254:3182-3.
2. Callaghan N, Garrett A, Goggin T. Withdrawal of anticonvulsant drugs in patients free of seizures for two years. N Engl J Med 1988. 318: 942-6.
3. Dreifuss FE. Epileptics and scuba diving. JAMA 1985. 253:1877-8.
4. Edmonds C, Lowry C, Pennefather J. Diving and subaquatic medicine. 3rd ed. Butterworth Heinemann, Oxford 1992 p470.
5. Shinnar S, Vining EP, Mellits ED, D'Souza BJ Holden K Baumgardner RA Freeman JM. Discontinuing anti-epileptic medication in children with epilepsy after two years without seizures. N Eng J Med 1985. 313: 976-80.

UKSDMC home Medical standards

 

[fisherdvm]

I would ask your neurologist if your symptoms are defined as petit mal seizures or not. If he said it is, it would be wise to follow standard recommendations like that above.

 

[TSandM]

Kingpatzer, I may be wrong, but I'm getting the feeling that you are really hoping one of us can give you some data that say that it's fine for you to dive with a known seizure focus in your brain, and none of us can or will do that.

You have seizures, proven by EEG. You are lucky, because they aren't (or haven't been) the full tonic-clonic kind that put people at extremely high risk of drowning while diving. But the reason yours aren't generalized is because the cells around the irritable focus are well enough behaved not to get involved in the action. Elevated oxygen tensions raise the risk for seizures -- it's one of the two primary toxicities of oxygen, and the most lethal. I would worry (and I'm QUITE sure there are no "data" to support this) that diving, especially in the deeper ranges, might make it possible for that seizure focus to generalize. Seizures underwater are almost always lethal, unless you are lucky enough to have them happen right in front of someone with unusual training and capacity.

The good news is that seizures related to head trauma often go away with time. Even someone who has to be put on antiepileptics can often be weaned from them after six months or a year.

I personally can't imagine what I would do if somebody told me I couldn't dive for six months. I'd be very hard to live with, but I'd rather be hard to live with than be dead.

The data you are asking for, I am quite sure don't exist. The type of seizure you have is unusual; the population of people with seizures who dive is small.

 

[Gene_Hobbs]

Did not have time to find this last night but...

Almeida Mdo R, Bell GS, and Sander JW. Epilepsy and recreational scuba diving: an absolute contraindication or can there be exceptions? A call for discussion. Epilepsia. 2007 May;48(5):851-8. Review. PMID: 17508997

 

[Kingpatzer]

TSandM:

No, I'm not hoping some one here can tell me I can dive (though I will admit I do adamantly hope I can). First, I don't believe that anyone should take anything said on a discussion board as professional advice -- particularly medical or legal advice.

Second, none of the people here have seen my scans, medical records and the like.

What I am trying to do is get as much information on available data, research and, if applicable, anecdotal personal experience, as I can so that I can have an in-depth discussion with my neurologist about my specific conditions and what they mean in my own specific case.

Considering I have plane tickets and hotels bought and paid for for a trip to Bonaire that leaves in a month is also certainly coming into play -- not only do I have a host of local dives coming up, I've got some major financial incentives to want to find the right answer as soon as possible.

No, I don't want to "settle" for not diving if my doctor and I can decide together that the level of risk associated with the activity is at worst a nominal increase in the inherent risk associated with diving. I'd rather dive with loads of restrictions (say, no more than 30' depth, no nitrox, limit of 1 hour diving per 24 hours, or whatever is appropriate) than not dive at all.

I won't take "don't dive, 'cause we don't know how this might affect you," as real advice -- because I'm just a very stubborn person. But if after significant research I find that the preponderance of the evidence suggests that for me diving is a really bad idea, I won't do it. I won't be happy (i really really really won't be happy) but I'd stop.

 

[fisherdvm]

If you are doing your divemaster training, you are already violating the standards of the program as a participant.

In the same way, once you reached your professional status as a dive instructor - will you simply let a student into your class with such condition? The liability issues - which you don't like me to bring up, is as important for you as a future instructor or divemaster, as it is for us who practice medicine for a living.

Call PADI, NAUI, or whom ever you are doing your professional training with, and they will CLEARY tell you if you can continue in your training, or if you should continue to dive.

 

[fisherdvm]

No, I don't want to "settle" for not diving if my doctor and I can decide together that the level of risk associated with the activity is at worst a nominal increase in the inherent risk associated with diving. I'd rather dive with loads of restrictions (say, no more than 30' depth, no nitrox, limit of 1 hour diving per 24 hours, or whatever is appropriate) than not dive at all.

You will not get such restriction from any competent professional. My guess is, you likely could get away with it in a 3 hour training confined water dive.... But you are still violating the restriction imposed by the consent you sign before every dive, or the consent you signed before you started your divemaster training.

 

[Kingpatzer]

I would ask your neurologist if your symptoms are defined as petit mal seizures or not. If he said it is, it would be wise to follow standard recommendations like that above.

The word "epilepsy" has not been used by my neurologist, and while I didn't write down his exact comments, they were far more general, along the lines of "your scan [EEG] shows a few brief, seizure-like activities lasting about 1-2 seconds . . "

In my state, people with petit mal or grand mal seizures are prohibited from driving. My neurologist has specifically said that he doesn't see enough evidence to report this to the dmv at this time.

To my knowledge, this is still under a diagnosis of post-concussion syndrome and not epilepsy; however, I've got a call into him to get the exact CPT codes for his diagnosis.

 

[DocVikingo]

Hi Kingpatzer,

If your primary purpose for visiting this forum is to, "...get as much information on available data, research and, if applicable, anecdotal personal experience, as I can so that I can have an in-depth discussion with my neurologist about my specific conditions and what they mean in my own specific case," then you appear to have a small start.

I would, however, point out that a number of the cited scholarly journal articles are lengthy and written in language that may not be readily understood by the lay reader.

Perhaps more importantly, there is room for very serious debate regarding the applicability of the cited literature to a post-head trauma picture involving "...a myriad of symptomes that have pointed to a neurological problem, including momentary disorientation, innappropriate mood swings, short term memory loss, auditory hallucinations and a few others."

IMHO, your situation will only be sorted out with the passage of time and treatment.

Wishing you an excellent recovery.

Regards,

DocVikingo