Seizure Disorders & Fits/Funny Turns

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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 - ENT specialist 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 (ENT specialist 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 & 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.

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer