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Transient Global Amnesia (TGA)

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Aeromedical Implications

Effect of aviation on condition

Some episodes of TGA have identifiable triggers
Known triggers for TGA that may be experienced in the aviation context include:
- Physical exertion
- Emotional stress
Other triggers not normally associated with aviation include:
- Painful experience
- Medical procedures
- Cold or hot water immersion
- Sexual intercourse

Effect of condition on aviation

Overt incapacitation
- Acute impairment of memory may impair ability to safely navigate and operate aircraft

Effect of treatment on aviation

There is no treatment for TGA

Approach to medical certification

Based on the condition

confirmed diagnosis of TGA
exclusion of other diagnoses
- Transient ischaemic amnesia
- Transient epileptic amnesia
Migraine is present in 25-33% of cases which may require treatment
Avoidance of identified triggers

Demonstrated Stability

Absence of symptoms of Transient Global Amnesia, Transient epileptic amnesia and Transient ischaemic amnesia for a period of one year
Absence of recurrent episodes of TGA

Risk assessment protocol - Information required

New cases

CASA requires a report from a Neurologist with respect to:
Diagnosis
Clinical status
- history of condition
- eye witness account of episode
- symptoms, including any visual or neurological symptoms, loss of consciousness
- onset, duration, extent of retrograde and anterograde amnesia
- identified precipitating factors
- any history of
  - head injury, faints, fits or funny turns
  - migraine (see severe headache section)
  - cardiovascular or cerebrovascular disease
  - family history of epilepsy
- cardiovascular risk factor assessment
- hospital assessment
- results of physical and neurological examination
- progress
Investigations conducted
- results of any imaging performed
Management
- treatment and effectiveness
- side-effects
- monitoring
Follow-up plan

CASA requires a review from a Neurologist 12 months post-event with respect to:

Diagnosis following 12 month period of observation
During 12 month period of observation
- Any recurrent episodes of transient amnesia
- Any history of faints, fits or funny turns
- Results of any additional investigations

Renewal

CASA requires a review from a treating doctor (GP or neurologist) with respect to:

Any recurrent episodes of transient amnesia
Any history of faints, fits or funny turns
Results of any additional investigations

Indicative outcomes

Initial notification to CASA and grounding required on diagnosis for a minimum period of 12 months
Clearance by CASA required before exercising privileges
Due to the risk of recurrent TGA all classes of medical certificates may be subject to long term restriction (e.g.multi-crew or safety-pilot)

Unfavourable

Any form of seizure disorder
Transient epileptic amnesia
Transient ischaemic amnesia

Pilot and Controller Information

TGA is an aero-medically significant medical condition.
There is no definitive test for TGA - it is a clinical diagnosis
Pilots and controllers who have been diagnosed with TGA are required to ground themselves and notify this condition to their DAME or CASA
Grounding required on diagnosis for a minimum period of 12 months for all classes
After 12 months a restricted certificate (multi-crew or safety-pilot) may be possible

Disclaimer

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