Scuba diving and epilepsy

Epilepsy Action believes that the current guidelines for epilepsy and diving produced by the UK Sports Diving Medical Committee are out of date and merit a review.

• In summary, the guidelines require a person with epilepsy to be seizure free and off medication for five years before they may be permitted to dive.
• The guidelines are referenced to evidence, the most recent of which is 15 years old and some of which is over 20 years old, and anonymous.
• In part they are medically inaccurate: they imply that “petit mal”, more accurately absence seizures, is not a form of epilepsy.

These guidelines effectively ban many people with epilepsy from diving, as once they are on medication most people with epilepsy are likely to remain on that medication for many years – even if they are seizure free. It is never possible to be certain whether coming off your epilepsy drugs might trigger a return of your seizures and the consequences that might have for the person with epilepsy, such as losing your driving licence, mean many people are unwilling to do so.

More information on stopping medication.

Epilepsy Action’s call for a review is based in part on review of the current evidence by an eminent epilepsy specialist, Professor Sander, published in Epilepsia, the leading epilepsy academic journal.

Summary:

"Recreational scuba diving is a popular sport, and people with epilepsy often ask physicians whether they may engage in diving.

"Scuba diving is not, however, without risk for anyone; apart from the risk of drowning, the main physiological problems, caused by exposure to gases at depth, are decompression illness, oxygen toxicity, and nitrogen narcosis.

"In the United Kingdom, the Sport Diving Medical Committee advises that, to dive, someone with epilepsy must be seizure free and off medication for at least 5 years. The reasons for this are largely theoretical. We review the available evidence in the medical literature and diving websites. The risk of seizures recurring decreases with increasing time in remission, but the risk is never completely abolished.

"We suggest that people with epilepsy who wish to engage in diving, and the physicians who certify fitness to dive, should be provided with all the available evidence. Those who have been entirely seizure-free on stable antiepileptic drug therapy for at least 4 years, who are not taking sedative antiepileptic drugs and who are able to understand the risks, should then be able to consider diving to shallow depths, provided both they and their diving buddy have fully understood the risks.” reference

(Maria do Rosario G. Almeida, Gail S. Bell, Josemir W. Sander (2007) Epilepsy and Recreational Scuba Diving: An Absolute Contraindication or Can There Be Exceptions? A Call for Discussion Epilepsia 48 (5), 851–858)

Unfortunately the paper is copyright and so we cannot make it fully available. It can be purchased from the publishers through this website. The National Society for Epilepsy has a slightly longer article about the paper.

The analogy comparing driving and diving and flying may seem simplistic but Epilepsy Action believes they bear comparison. In the UK a person with epilepsy may not drive unless:

they have been seizure free, on or off medication, for one year
or
only experienced sleep seizures for a period of at least three years
and
the DVLA/DVLNI is satisfied that as a driver you are not likely to be a source of danger to the public.

After one year of seizure freedom therefore a person with epilepsy can drive any car or motorbike, Category A or B licence, up to 3.5 tonnes with eight passengers, at up to 70 mph on any UK road.

The National Private Pilots Licence requirements  for an individual to fly solo or with a safety pilot mirror the UK driving regulations for private driving.

As can be seen these requirements are much less stringent than those for diving although the risks of a seizure in either case are – we would suggest – likely to be as, if not more, severe.

Epilepsy Action undertook an online survey in autumn 2007 with divers around the world to find out about their experiences of epilepsy and diving.

We would not claim these are in any way scientifically definitive: the participants were self selected, no medical or other review has taken place with these people and the number of respondents is very small. However, we do believe the results paint a picture of some real experiences of people with epilepsy and diving.

28 people replied to our survey and the following summarises the results:

• 28 surveys completed
• 18 have dived with a diagnosis of epilepsy
• 12 took up diving after diagnosis of epilepsy
• 16 on anti-epileptic drugs
• 10 seizure free
  • Five: diving more than five years
  • Two: less than 10 dives
  • Two: 10 – 20 dives
  • Two: 20 – 50 dives
  • One: 50 – 100 dives
  • One: 100 – 250
  • Two: more than 250
• Eight not seizure free – three have between 20 and 50 dives
• One had a seizure while training (someone who had frequent seizures anyway)
• One had seizure warning whilst diving but no seizure
• All the others have been incident free in relation to their epilepsy
• Of the 18 diving
  • 10 always tell their buddy
  • two sometimes tell their buddy
  • six never tell their buddy
• Of those that told their buddy (more than one response from some)
  • four buddies refused to dive with them
  • six took extra precautions
  • 11 dived as normal

Some of the reasons given for telling or not telling the buddy were:

“I explain my simple partial seizures only affect me in terms of ‘daydreaming’ and haven’t had one in set time”

“I don’t have a problem going with other people…….if I have a seizure I get auras first”

“Most did not understand and had incorrect views/opinions”

“Because I wanted to take part”

“Because of the stigma”

It is clear from our survey that some people with epilepsy are diving against the current guidelines of the UK Sports Diving Medical Committee.

Epilepsy Action is inviting the UK Sports Diving Medical Committee to join a working group to formally review the evidence in relation to epilepsy and diving. We hope that they will join this group and see if the current evidence merits an effective ban on diving for most people with epilepsy or whether they can be relaxed.

If you would like to comment on this and agree or disagree with the request for the guidelines to be reviewed please contact us.

Simon Wigglesworth
Deputy Chief Executive
7 January 2008