January 2008
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believes that the current guidelines for epilepsy and diving produced by the UK Sports Diving Medical Committee are out of date and merit a review.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)
- This paper is available free of charge from the Wiley Online Library
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.
Comments: read the 16 comments or add yours
Comments
Hello, I am seizure free for 17 years (I am 36) and without treatment for 17 years. I had 5 seizures between 13 and 19 years old, the 3 (13 and 15 y.o.) first were diagnosed and treated as tetania. At 17, ECG and MRI were done. A sensitivity to flashes with a specific frequency and cavernoma were observed. Nevertheless, I am seizure free for 17 years. I dived several times (before 17 y.o.) and would like to dive again. But in France, no medical doctors agreed to complete a certificate for me. What would be the BSAC's opinion? What do I have to do to obtain a certificate from a BSAC doctor and does it include restrictions? Many thanks. Best regards. Cécile
Dear Cecile,
First may I apologise for the late response to your question. Here are the rules according to the UK Sports Diving Medical Committee. As you have been seizure-free and without medication for over 5 years, you would be allowed to dive. This is the only board whose information I know about. And of course it applies to UK guidelines, rather than other countries. I hope that helps.
Cherry
Advice and Information Team
Hello,
I am very interested in your current campaign to change the diving guidance for epileptics. I was diagnosed six years ago (partial complex) and once on Tegratol I became completely stable, the only reason I have not come off is that I do not want to run the risk of losing my license, on which my job depends. I have also been diving for 8 years (always abroad when on holiday) and up until this year (2011) have either never been asked for a medical certificate or if asked I’ve explained that I don’t have one and they have over looked this and let me dive, I have never hidden my epilepsy when asked and all my experiences had led me to believe that it was not crucial.
This year however I was asked, told the truth and for the first time I was refused a dive which has led me to your site. I was dismayed to find out that I had to be off medication, as I love this sport. Can you tell me how your campaign is going, how close you might be to changing the current guidance and is there anything I can do to help?
Kind regards,
Alison Hatfield
Epilepsy Action is aware that for well over a year the UK Sport Diving Medical Committee http://www.uksdmc.co.uk/ have been undertaking a review of the medical rules for epilepsy. Despite our best attempts they have refused to allow us any input in to this.
We have recently heard that a paper reviewing the guidelines has been submitted to an academic journal. We have also been told there are no plans to change the guidelines. Once the paper is published we will review the basis for their policy with expert epileptologists and decide on the next course of action.
Epilepsy Action
It makes me cross at the way scuba diving organisations are with people with epilepsy. I have dived all over this world without any ill effects and down to 40 metres many times, i have also dived all year round in the uk for the past 5 years. I plan on beating all the odds and becoming a dm . Don't take no for the answer ,i never have and never will. I have been clear for 9 years and i hold a driving licence. I have good dive buddies, some who know and some who don't. It should be done on each individual case as i feel there is still a victorian stigma in the medical profession regarding epilepsy and diving, after all they cannot wrap us all up in cotton wool to sit and do nothing. I will carry on diving and hope to prove that current thinking is antiquated.
Absolutely the law needs reviewing! I have wanted to dive for years but cannot due to my mild epilepsy. The fact is that I have only ever had 2 fits, and the last one of those was 15 years ago (I am not 100% convinced that I even have the condition)! The reason I was quoted was because of the way that medication reacts at depth. I am not convinced, and it would be nice to have some kind of proof, as I really would like to take this up. I find it strange how we are continuing with antiquated laws that really should be updated more frequently, especially as we learn more and more about our condition.
Are there any recorded cases of actual diving accidents caused by an epileptic seizure? I cannot seem to find any but I feel it would be helpful in figuring out what to do in case it happens since people are obviously diving with the condition.
Instead of avoiding it, why not include seizures ( and any loss of consciousness ) in the safety training of dive courses? ( in fact I know PADI already does this ) There are many things of which could cause a diver to lose consciousness and trained, certified diver should be prepared to handle the situation appropriately. A seizure due to epilepsy is not that much of a special case scenario.
Also, it seems there is a very simple solution that would render even the most at-risk of seizure epileptic in the same safety level as any other diver: a full face mask. This will prevent drowning, it then just becomes an issue of someone noticing the diver in trouble and safely getting them to the surface. Doesn't seem any different than any other safety situation under water.
To add to my confusion many sites say that because during a seizure people hold their breath they are at risk of lung expansion. But then they also say that they will sink to the bottom and so can only do shallow dives. Well, which is it? If holding breath is an issue than we need to learn to empty someones lungs before ascending. As for sinking, well anyone can sink, watch out for you buddy.
Really, this is just the dangers of normal diving that dive associations are claiming become unhandleable when it has to do with a person having epilepsy.
Has anyone had any luck contacting these boards and getting a good explanation why certified divers are not taught how to deal with someone losing consciousness while under water?
Hi James
I can appreciate your frustration, and we’re not aware of any recorded cases of actual diving accidents caused by epileptic seizures. However, we do not have the technical knowledge or information about scuba-diving to be able to answer your questions. You’ll get more detailed answers by approaching the scuba-diving training agencies directly.
You could also contact the Health and Safety Executive for some answers. This is because all dive schools in the UK are required, by law, to comply with the Diving At Work Regulations 1997.
I hope you find the information you are looking for.
Advice and Information Team
Can you please tell me if any further action has been taken since this article was written?
My son is 22 and was diagnosed with epilepsy when he was 15, he stopped taking his medication when he was 19 on the advise of his consultant and had no further siezures until just over a week ago.
His consultant now wants him to go back on medication but he's resisting as he wants to get back to diving and knows that at present he cannot dive if he's on medication!
Hi Jane
I’m sorry to hear that your son’s seizures have come back, he must be very disappointed.
You mentioned that he doesn’t want to take epilepsy medicines because he wants to scuba dive. Do you think your son might not fully understands the risks of having seizure while scuba diving? So it’s not just the epilepsy medicine that would stop your son from scuba diving.
The British Sub-Aqua Club say that people with epilepsy should be free from awake seizures and off medication for five year. If he only has seizures while asleep, he should be seizure-free and off medication for three years.
While your son might not want to know about other sports at the moment, there are lots that he should be able to do. If he’s shows an interest you could tell him about our sport and leisure information.
Advice and Information Team
Very interesting to read the outcome of your survey which is now 5 years old - have you repeateed it or do you have plans to do nso ?
I have scuba dived before in Israel, Malaysia and the Phillipines, all on "resort" certificates which involved swimming pool training and dives at no more than 10 metres. At no stage was I asked whether I was suffering any condition or taking any medication. The only time I have been refused a dive was in Turkey where the booking office allowed me to sign up even after completing their medical questionaire fully and disclosing my condition. It was olnly on the dive boat itself that I was refused a dive - my family never went below 10 metres in that session - which to be frank was all that we wanted or needed top do. I have been diagnosed ep[ioleptic since the age of 14, and apart from a seizure in 1988 (after not taking any medication for approx 10 years at that stage).
Like many of you correspondents I do not want to stop taking medication due to the possible side effects and impact on my working and social life (losing my driving licence alone would be a major impact).
I am a regular marathon runner, competed in several triathlons and regularly cycle 40 - 70 miles on a road bike for weekend relaxation. I accept I will never deep dive but am disappointed that I will not be allowed - if truthful when asked - to even experience some of the sights available around the world at shallow depths.
Like many of your correspondents I continue and at no stage have I
i had petit mal when i was 5 it only lasted 2 years till i was 7 its been over 10 years since i had my last episode but the dive centers wont let me go without getting a signature from a doctor that says its fine to dive. i tried several doctors but none of them want to take the responsibility.10 years is along time i don't understand why the doctors don't want to sign my release.Does anyone know if i should risk going diving because i really want to try to dive ive been waiting for a signature for over 2 years now. thanks for reading :)
Hi. As you say you've been seizure-free for over 10 years you should be able to dive, providing you have also been off medication for five years or more. (This is unless there is any other medical reason meaning it would be unsafe for you.) If you do meet this criteria, you might want to ask your doctor why they are refusing to sign your release for you to be able to dive.
As you will know from reading this web page, Epilepsy Action believes the diving regulations around epilepsy are in need of review. Unfortunately, at this time, this has not happened.
Shelley, Epilepsy Action advice and information team
Mike: We have recently found some more information which may be helpful.
If you are off medication and your own doctor continues to be reluctant to sign for you, you could find the details of dive medical referees on the UKSDMC website http://uksdmc.co.uk/ One of them might be happy to review your situation and consider signing a medical form for you. If you still can’t find anyone to sign, then you could contact our deputy chief executive, Simon Wigglesworth, who has a personal interest in this subject. You can reach him using the form at http://www.epilepsy.org.uk/comment/reply/1537/4090
hi there,
I will like to ask what about cases like mine. I was diagnostiqued with epilepsy at the age of 16, since then I´ve been treated with Depakine 500 (Valproic acid). My doctor tried to take my medication off after 6 years of no seizures but unfortunally after 12 months of none medication I suffered one episode.
Since then I´m back to my normal medicine and back to normal again for 6 years.
My question is: If people like myself are totally stable while we are under medication, can we dive?
Regards
Hi Arturo
In the UK it’s recommended by the British Sub-Aqua Club that you are free from awake seizures and off medication for five years if you want to go scuba diving. If you only have seizures while asleep, you should be seizure-free and off medication for three years.
However Epilepsy Action believes that the current guidelines for epilepsy and diving are out of date and should be reviewed.
If you wish to keep up to date with this campaign please visit our campaign webpages.
Diane
Advice and Information Team