Seizures: Medical Causes and Management (Current Clinical Practice)
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Aeromedical Disposition military : A history of febrile convulsions before the age of 5 is waiverable for military entry into flight training, but requires normal neurology consult, EEG studies, and MRI scan at a minimum. Convulsive movements during G-LOC while centrifuge training will not require waiver application or put the aviator at risk to be disqualified. Truly epileptiform abnormalities such as spikes, sharp waves, and spike-wave complexes are disqualifying.
However, other EEG findings considered normal variants, small sharp spikes [SSS], benign epileptiform transients of sleep [BETS], wicket spikes, 6 Hz [phantom] spike and wave, rhythmic temporal theta waves of drowsiness [psychomotor variant] and 14 or 6 Hz positive spikes are not necessarily disqualifying. All other cases of convulsive episodes or altered consciousness events compatible with possible epilepsy, whether treated or untreated, are disqualifying and resulting in immediate grounding action pending further evaluation.
Aeromedical Disposition civilian : Everything that has been mentioned in the aeromedical disposition equally applies to the civilian sector. The history as obtained from a witness is most important! Epilepsy or seizures are one of the Fifteen Specifically Disqualifying medical conditions. For a single idiopathic seizure, the FAA policy is that the airman is denied their medical certificate for any class for four years and must be off medications for the most recent two years.
For two or more seizures the airman is denied medical certification for ten years and must be off medications for the most current of three years. Should a seizure be a manifestation of a treatable medical problem and that problem is adequately treated the airman may be granted medical certification earlier than mentioned in the previous sentences. An example would be a treatable brain tumor. Even if the airman is adequately treated the antiepilepsy medications are not acceptable. The side effects of these medications are incompatible with aviation duties. Febrile seizures prior to the age of 5 or seizures clearly due to a toxic etiology are not disqualifying.
Benign childhood epilepsy syndrome may be considered after obtaining neurologic opinion. Waiver Experience military : No patients with the diagnosis of epilepsy have received waivers to date. In aviators with provoked seizures and a history of childhood seizures, consideration for a waiver to return to flying duties is entertained. In the US Air Force database, a total of 65 cases were noted that carried a diagnosis of seizure disorder of some sort requesting a flying waiver. Of that total, 25 were granted a waiver for an approval rate of Ten waiver applicants were for initial pilot training, six were for a trained pilot or navigator and the remaining nine were for non-pilot aircrew.
In each of the 25 cases, the history was for childhood febrile or infantile seizures or for provoked seizures. There were no listed approved waivers for the diagnosis of epilepsy. Engel, Jerome, Jr. Seizures and Epilepsy , Philadelphia : F. Davis pp Annergers, J. Edited by Elaine Wiley. Al-Naamani, K.
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