epilepsy
I have a non-medical friend who is a Divemaster. 9 months ago she suffered a focal seizure (luckily on land!) and was subsequently diagnosed with a left fronto-parietal low grade astrocytoma.
This was excised and she suffered two further focal seizures in the immediate post operative period. She has made a full recovery from the surgical point of view. She is cuerrently taking Kappra, 500mg bd, and has been advised that she needs to be seizure free for 2 years on teatment before seeing how things go off treatment.
It is very difficult to find any information about her future with regards to diving again.
This situation is different to that of primary epilepsy as her first seizure was due to the effects of a SOL (space occupying lesion) and it is likely the subsequent two seizures were related to post-operative oedema.
Does anyone know whether she can dive again and, if so, what criteria need to be satisfied?
Dr Al Quinn
I am one of the members of the UKSDMC with an interest in epilepsy. I recently reviewed the subject, as there is a concerted effort on the part of one or two individuals to get diving organisations in the UK to allow epileptics to dive. I am therefore interested to see comments on this subject, and I welcome the reply from Mike Bennett.
Our view is that the prospective diver should be fit-free off all medication for a minimum period of 5 years. There is some evidence from drivers in the UK that the risk of having a further epileptic fit after this period is no greater than in the general diving population. Given that the diver mentioned has had two fits post-surgery (which is not surprising, given where the astrocytoma was located) then I think that she should be on medication for some time before trying to come off. Some suggest two years, others longer. No matter what happens, it will be some time before she can be considered as fit to dive.
Dr. Chris. Edge
The generalconsensus is that epilepsy is an absolute contraindication to being passed fit to dive.
However, the UK Sports Diving Medical Committee (BSAC) will consider someone fit if they have been seizure free for 5 years off medication.
DAN do not share this view.
Like so many situations, this is not expressly covered in the guidelines of the SPUMS medical.
I agree in this situation, that the candidate does not have 'epilepsy', but rather is someone who has suffered seizure(s). There is a difference.
My personal approach would be to insist on a good period off medication and seizure free (5 years??) before allowing diving.
Mike Bennett
As someone who has epilepsy, and had a few fits when I was younger, I would not want to have a fit underwater. It would almost certainly be fatal.
However, modern anti-convulsants can be very effective, and for a patient who is prepared to take medication assiduously, and follow the "lifestyle restrictions" required, the results can be impressive.
In my case, I have been siezure-free for 28 years. I hold down a full time job, drive a car, have sailed small boats, and have a Bronze Medallion in lifesaving.
Dr Edge mentions the UKSDMC regulations, and this is an interesting point of view.
However, it is not the only view. Dr David Sawatsky, for example, in his book on Dr Sawatsky's Diving Medicine Notes, has article on Epilepsy and Siezures which makes fascinating reading.
Dr Sawatzky's article says (in part) "For the epileptic who is well controlled on medication, has no noticeable side effects from their medication, has been more than two years since their last siezure, has a very good and mature understanding of their disease, I would allow them to dive but only under friendly conditions (warm water, good visibility etc) and even then only to a maximum depth of 50 fsw (15 msw)".
If I were a doctor, and epileptic asked me to pass them fit for diving, would I sign the form? I have to admit that wouldn't be an easy decision.
Charles Perry
Brisbane