Seizure disorders and fits - funny turns

Guidance for medical examiners when assessing a patient for either a general topic or condition - seizure disorders and fits.

Definition

This applies to any history of fits, faints, funny turns, seizure, loss or disturbance of consciousness at any age.

For assessment of seizure related to head injury, please see CPG on Head Injury

Aeromedical implications 

Effect of aviation on condition

• Exposure to unavoidable provocative factors e.g. strobe lights, propeller flicker, fatigue, hypoxia etc
• Sleep deprivation
• Time zone changes and shift work may adversely affect medication efficacy

Effect of condition on aviation

• In-flight seizures have catastrophic consequences
• Increased risk of subtle and sudden incapacitation
• Medication used may adversely affect psychomotor function

Approach to medical certification

Based on the condition

• A confirmed diagnosis, supported by evidence, is important to stratify risk
• Epilepsy and seizure disorders do not meet the regulatory standard

Based on treatment

• Use of anti-epileptic medication is not acceptable in the aviation environment

Demonstrated stability

• Time period for demonstrated absence of seizures off medication is a minimum of 10 years in most cases
• Abnormal EEG diagnostic of seizure disorder is usually an indication of ongoing risk of seizure and does not meet the regulatory standard

Risk assessment protocol - information required

New cases - Neurologist or treating doctor report (depending on condition)

• Confirmed diagnosis (with reference to eye witness, ambulance records, emergency department hospital records and specialist reports.)
• Clinical status
• Investigations conducted – CT, MRI, EEG
• Other tests and interventions previously undertaken
• Management
  • treatment
  • side-effects
  • monitoring
• Follow-up plan.

Renewal (Neurologist or treating doctor)

• Treating doctor report confirming seizure-free and absence of provoking factors: e.g. alcohol
• No medication

Indicative outcomes

After 10 (ten) years off medication and seizure-free, the following considerations may apply.

Favourable

• Simple childhood febrile seizures
• Provocative factors no longer present

Unfavourable

• Diagnosis of epilepsy or known seizure disorder
• Multiple seizures, particularly if unprovoked
• Complex febrile seizures
• Post traumatic seizures
• Provocative factors present in aviation
• Abnormal investigations – Neuropsychiatic assessment, MRI, EEG
• Requirement for anti-epileptic or other prophylactic medication

Pilot and controller information

• Any seizure disorder is not compatible with flying or controller duties. No restrictions adequately reduce the risk. For example, a co-pilot may be unable to assume control.
• Contemporaneous comprehensive history including statements from eye witnesses, ambulance records, emergency department and hospital records is essential for accurate diagnosis
• Reliance upon medication for seizure controls introduces an additional set of risks, including side effects and difficulties with varying levels of medication in the body
• Diagnostic uncertainty will usually require a demonstrated absence of seizures of a minimum of 10 years