Diving & Epilepsy

[DrSteveJohnson]

But there obviously is a consensus that at some point, epileptics are well enough to drive...If a doctor is willing to sign off, why not use that as criteria to say that the person is well enough to dive....Seems to me if they are well enough to drive, they are well enough to dive.

I listened to a very eloquent presentation by a representative of one of the epilepsy charities at a dive medicine conference last year. Whilst everybody had enormous sympathy for his cause, the general conservatism of the dive docs present wasn't altered.

The reasons for this are several:

The unpredicatability of epilepsy which effectively means that risks may seem low of a seizure but never approach zero.
The fact that the dive environment is probably likely to promote fitting in individuals prone to seizures (pressure, gas tensions, sensory deprivation, stress etc).
The sedative nature of many epilepsy drugs and the unknow effects of these in the hyperbaric environment.
The dire consequence of a seizure underwater where drowning is a near certainty.
The innate conservatism of the medical profession.

Docs are conservative (amongst other reasons) because:

If Doctor X were to see and declare fit 100 people with a history of epilepsy whom he thought had a very low risk and in the following years one of those had a seizure and died then Doctor X is going to be successfully sued by the deceased family because he has strayed away from accepted medical thinking. Thus, doctors are unlikely to express opinions very different from their colleagues which means the status quo is maintained.

In the UK, divers with a history of epilepsy are allowed to dive if they have been fit free for 5 years off medication (or 3 if their fits were nocturnal). I'm not sure how many divers fall into that category or whether there has been any long term follow-up of these divers. Gathering data on these divers may be useful to look at the risks.

The other group who should be studied are those with epilepsy that do dive on medication who do so either without or despite medical advice. Some form of anonymous survey and follow-up might contribute a lot to this discussion.

Best Wishes,

Steve

 

[austriandiveress]

Steve, thank you for this very interesting report. I'd like to ask: in the view of the medical community, what is the difference in signifigance between a nocturnal seizure and one which might occur during the day, as related to diving ?

 

[DrSteveJohnson]

Steve, thank you for this very interesting report. I'd like to ask: in the view of the medical community, what is the difference in signifigance between a nocturnal seizure and one which might occur during the day, as related to diving ?

Good question. I think that there is an assumption that seizures that occur whilst asleep are less predictive of seizures occurring whilst fully awake than a history of day time seizures. In the UK the authority that issues driving (not diving) licenses is less punitive to car drivers with nocturnal epilepsy than daytime epilepsy. I would guess that the diving regulations reflect that. However, I'm more than happy to be corrected if wrong!

Any neurologists here?

Steve

 

[masterof0]

So no luck even if they are fit free with preventative medication? (To your point, docs are conservative by nature so it seems like the would keep someone on meds just to reduce the risk of a seizure)

Although I do understand, and appreciate, the conservatism associated with the medical community, my ultimate question still comes back to the changing ideals of the certifying agencies. If they are willing to certify individuals who have epilepsy, then how do we use these individuals (for those who are willing to participate in a study) to either prove or disprove the link between diving and epilepsy (or are there specific depths, conditions, etc, that consistently trigger seizures)? Without that information I don't know that we will ever get past this hurdle.

 

[fairybasslet]

I thought the use of the word "fit" went out with lobotomies.

 

[DrSteveJohnson]

I thought the use of the word "fit" went out with lobotomies.

I'm sorry if the word 'fit' in relation to epilepsy caused any offense. I guess it is still in common parlance in the UK. Just another example of two nations separated by a common language.

Steve

 

[DrSteveJohnson]

Although I do understand, and appreciate, the conservatism associated with the medical community, my ultimate question still comes back to the changing ideals of the certifying agencies. If they are willing to certify individuals who have epilepsy, then how do we use these individuals (for those who are willing to participate in a study) to either prove or disprove the link between diving and epilepsy (or are there specific depths, conditions, etc, that consistently trigger seizures)? Without that information I don't know that we will ever get past this hurdle.

There are small, observational studies that confirm what we already know, some people with epilepsy do dive. Gathering data from them on their medical history and experiences would be a useful exercise....

Steve

PS Just found this: http://www.epilepsy.org.uk/campaigns/surveys/scubadiving#comment-419

which relates to the presentation I mentioned in my first post.

 

[masterof0]

Something that just came to mind is the biggest concern that I have heard for not diving with epilepsy is the discharge of the regulator and drowning. I do understand that this is not the only concern, but couldn't this issue be mitigated with the use of a FFM?

Thanks Dr Steve. I hope that this article triggers some discussion as these are the same questions that I have regarding epilepsy and diving. The irony that i see to it all is that the agencies only require doctors approval in the US. As it stands right now, none of the doctors have a guideline to follow, only "gut" feel about the patient.