Diving & Epilepsy

[nereas]

This thread is also of interest to me. I'd like to ask: what about other health conditions that can cause an unexpected loss of conciousness?
As far as I know, diving with diabetes is not forbidden, with the exception of deco dives. Of course you could argue that a diabetic who monitors their glucose level before a dive is at little risk, but then so is an epileptic who has been seizure free for years.....
Of course no diver should put a fellow diver at risk or in a position where they are unprepared for a medical emergency, but I personally advocate tolerance such as that shown by masterof0 and fairybasslet.

Some agencies will certify a diabetic, whereas others would not.

Last that I heard, NAUI does not, but that may have changed. It has been awhile since I checked the NAUI rules.

Any instructor, and any course director (store owner) can refuse to certify anyone based on any medical condition. It all depends on how safe the store and the instructor want to guard their own reputation. Nobody wants to have a former student die on scuba. That has a tendancy to be remembered in the local community.

Insulin dependent diabedes, PFO, asthma, cerebral palsy, epilepsy, and a history of heart attacks are the primary reasons for refusal of scuba certification, as I recall. But it all depends on the agency, the shop, and the instructor.

Some instructors and stores will certify anybody. A few even have a don't ask / don't tell policy, of sorts.

Others are more discrete.

 

[austriandiveress]

"Any instructor, and any course director (store owner) can refuse to certify anyone based on any medical condition."..... Nereas, I appreciate your answer and I certainly understand your point. Nevertheless: would an instructor /course director refuse to certify an overweight, chain-smoking middle aged man, who has the funds to participate in any number of courses? (maybe so, then I will shut up!)
I've seen plenty of such guys diving: the "deco beer (s)" between dives is all a part of a fun day out, apparently. One could argue that they are a heart attack or stroke waiting to happen. Would an accident involving such a person also taint the reputation of the dive shop/store owner? Where does one draw the line?
I think I'd rather dive with a person who has a recognized, well-maintained, treatable illness who behaves and dives responsibly than a person who neglects their general health and engages in potentially risky behavior.

 

[nereas]

Well, like I said, it all depends on the store, it's owner(s), and the specific instructor.

Some stores will certify anyone simply because money is green (it's green in the USA and multi-coloured in Europe). But not all stores.

I used to teach for a fairly conservative store, and we then did not accept students with insulin dependent diabedes, PFOs, asthma, cerebral palsy, epilepsy, or a history of heart attack. This was the store's stated medical mantra. It is perhaps a more simplified and conservative rendition of NAUI's contra-indications, which are stated differently and in more detail.

I don't know what they are up to now. I haven't spoken with them lately. I have been too busy and they have been too busy. I also have not kept current with NAUI's medical list.

If you are asking whom I would rather dive with, the answer would be a triathelete.

In reality, I dive with a lot lesser folk, and I watch them like a hawk every minute, and stay really close. Still, I would not be really comfortable if I knew any of the above contra-indications were present in their bodies.

 

[austriandiveress]

I hope that your triathlete doesnt have a panic attack at depth!

I appreciate the certification information, thanks!

 

[mikes351]

Isn't the point diving and epilepsy? Anything can happen to anyone at anytime. Being in the best physical condition hasn't stopped people from dropping dead of a heart attack or for someone that smokes and drinks to live to a 100. Point being that we must not take risks that endanger ourselves or others, especially if they are students. I have followed the ongoing discussion regarding epilepsy, since we have a daughter that is epileptic, but until there is clear evidence that diving and epilepsy go together and PADI will accept a doctor's sign off she isn't learning to dive. Why? Not because I don't want to teach her but I don't want to violate standards nor endanger her. Regarding drinking and diving, not on my trips -- your money isn't worth it!

 

[masterof0]

... but until there is clear evidence that diving and epilepsy go together and PADI will accept a doctor's sign off she isn't learning to dive.

I totally understand your position. Unfortunately, this is not one of those where there is a clear cut answer. I think there is one key component that is not being addressed by this conversation and that is the different classifications of epilepsy/seizure disorders. Not only does the amount of time seizure free play a part in a person's abilty to get certified, so does the type (petty mal vs grand mal) of seizure that the individual suffers from.

Based on my correspondence with PADI, SSI, and SDI, a doctor can sign off and give approval for an epileptic to be certified.

 

[DocVikingo]

"Epilepsia. 2007 May;48(5):851-8

Epilepsy and recreational scuba diving: an absolute contraindication or can there be exceptions? A call for discussion.

Almeida Mdo R, Bell GS, Sander JW.

Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.

Recreational scuba diving is a popular sport, and people with epilepsy often ask physicians whether they may engage in diving. Scuba diving is not, however, without risk for anyone; apart from the risk of drowning, the main physiological problems, caused by exposure to gases at depth, are decompression illness, oxygen toxicity, and nitrogen narcosis. In the United Kingdom, the Sport Diving Medical Committee advises that, to dive, someone with epilepsy must be seizure free and off medication for at least 5 years. The reasons for this are largely theoretical. We review the available evidence in the medical literature and diving websites. The risk of seizures recurring decreases with increasing time in remission, but the risk is never completely abolished. We suggest that people with epilepsy who wish to engage in diving, and the physicians who certify fitness to dive, should be provided with all the available evidence. Those who have been entirely seizure-free on stable antiepileptic drug therapy for at least 4 years, who are not taking sedative antiepileptic drugs and who are able to understand the risks, should then be able to consider diving to shallow depths, provided both they and their diving buddy have fully understood the risks."

Regards,

DocVikingo

 

[ScubaDocER]

Diving with seizures always presents a serious risk not only to the diver, but to the dive buddy who may have to attempt a rescue. Previous posts have mentioned the concept of medically clearing someone to dive with seizures. I am not sure any reasonable physician would do so. There aren't enough studies substantiating the notion of diving with seizures. I am not sure any physician would sign off on it. I certainly would not. The only occasion that I can envision medically clearing someone to dive who has had a history of seizures is if they had febrile seizure during childhood. Those resolve once out of childhood and do not recur in adulthood. While there is a statically small risk of seizures, it is so low that I would clear someone who had a febrile seizure under those circumstances. Even with medical treatment, seizure patients will often continue to have seizures. The goal of medication is decrease the frequency of seizures, not to eliminate them from happening. It is generally accepted that these patients may still have seizures, just less frequently. Because it is hard to predict which patients on medication will seize and which will not it presents a substantial risk to the person who chooses to dive with seizures. A single occurring seizure may warrant discussion for allowing someone to dive, but seizures requiring continuous medication should not be allowed to dive. The risks are too great both for the diver and the Instructor who certified them. People typically don't dive from seizures. They die from drowning, aspirating, trauma, or other events related to the seizure. This excludes seizures from toxins, drugs, etc. While I am empathetic to any person with a medical condition, the combination of active seizing and diving will almost always prove fatal.

 

[masterof0]

There aren't enough studies substantiating the notion of diving with seizures.

Are there any active studies to prove/disprove this? If there are, how does someone who has epilepsy get involved with such a study?

Also, as you know, there are differing degrees of epilepsy. Based on what I am reading from this thread, I think the assumption is that epilepsy=grand mal seizures. What about some of the less severe forms such as the "aura" or petty mal seizures where your motor skills and subconscious behaviors are not impacted?

 

[ScubaDocER]

I am not aware of any active studies involving seizures and diving. The problem is that you would have to get people with seizures to consent to dive and monitor whether or not a seizure occurs. If it does, they stand a very good chance of drowning. I am not sure many people would want to volunteer for such a study. Otherwise, it is a theoretical discussion. Absence seizure — also known as petit mal seizure — involves only a brief, sudden lapse of conscious activity. Compared with other types of epileptic seizures, the petit mal variety is very mild. But that doesn't mean they can't be dangerous. Children with a history of absence seizure must be supervised carefully while swimming or bathing, because of the danger of drowning. Any time you have lapse of consciousness underwater, your risk of drowning increases significantly.