Let's Open a Can of Worms - Epilepsy in Diving

Recently a customer (already certified to dive) walked into our store and indicated an interest in becoming a DM then Instructor. After talking with her about a plan of action for more than 30 minutes... she dropped the "oh, by the way... I have epilepsy, caused by brain cancer." Not something I hear from a leadership candidate everyday.

So I started some hard research and luckily DAN (in the New March/April Issue of Alert Diver) has an article about Diving with Epilepsy (see page 22 of the magazine.)

DAN, I think most all of us agree is a leading (if not primary) leading authority on Dive related research. They start the article with "Epilepsy is perhaps one of the few worldwide diseases that most medical professionals agree is an absolute contraindication to safe diving."

The key words here are "perhaps" and "most." Both leaving room for interpretation and the possibility that diving with epilepsy is possible. They didn't help me any further by concluding the article with "The only real truth in the matter is that absolutes can be invalid. As Les Luthiers, a comedy-musical group from Argentina, said "absolute truth does not exist, and that is absolutely true."

So to get to my point... DAN is now using ambiguous and irrelevant quotes to help us determine what is safe and what isn't? I can only assume by the final conclusion made in the quote.. that epilepsy is not an absolute contraindication for diving according to DAN.

So my final question in this discussion is for anyone out there. Is it safe for epileptics to dive? They legallly drive cars in many places. This I believe is far more dangerous than diving. If they have a seizure underwater, they are likely only to harm themselves. If they have a seizure on a highway, they could wipe out 20 cars and take numerous lives and cause untold numbers of injuries?

If a doctor signs off that she is fit to dive (and instruct)... would you as a shop owner hire her? Would you as a student want her to teach you? Would you as an Agency approve her Instructor rating?

I'm asking all these questions hoping for some straight answers. She was a super nice girl and I want to help her... but I also want to have as many opinions as possible to help us come to a rational decision... both for her, her family, our store and her potential students.

Anyone out there diving with epilepsy... I'd especially appreciate hearing from you...

Safe and Happy Diving to All...

I think the worst thing here is that having some problem underwater while teaching a student might scare the student and push him/her to do something dangerous, in order to help her.

But if there's somebody with her (another DM/instructor), maybe this could work. The problem is if you or anybody else is ready to make the effort to help her in this dream.

She has to have her physician sign off on diving for DM certification. That pretty much takes the decision out of your hands.

Right or wrong wouldn't a shop owner or agency using a medical condition that has been cleared by a physician to "discriminate" face obvious problems

What tna9001 said. Also, you can teach her but you don't necessarily have to hire her.

This is not really opening a can of worms... It has been brought up in the main stream medical literature recently:

Almeida et. al. abstract:

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.

Click to expand...

Almeida Mdo R, Bell GS, Sander JW. Epilepsy and recreational scuba diving: an absolute contraindication or can there be exceptions? A call for discussion. Epilepsia. 2007 May;48(5):851-8. PubMed ID: 17508997

It is also known that people do dive with epilepsy...

Taylor DM, O'Toole KS, Ryan CM. Experienced, recreational scuba divers in Australia continue to dive despite medical contraindications. Wilderness Environ Med. 2002 Fall;13(3):187-93. RRR ID: 7646

It could be worth a letter to the chair UHMS Diving Committee (Dr. Mitchell) if you would really like to see this re-evaluated formally by the diving medical community. UHMS is always requesting workshop ideas and it has been years since the last "Fitness to dive" so that could also be worth consideration. (1987, RRR ID: 4249)

If outside the US, SPUMS or EUBS are worth contacting.

The seizure risk issue is more complicated than just epileptics, too. Some medications, such as at least some antidepressants (which are used for a wide range of things aside from depression), are associated with an increased risk of seizures (although often still very low risk).

I met a recreational diver on antidepressant therapy who dealt with the issue to using a full face mask and always diving with a buddy. This does not make a person invulnerable to dying due to seizure while diving, of course.

The thinking was this; a seizure is said to be a 'non-survivable event' while diving; you lose consciousness, spit out your regulator and inhale water during a generalized convulsion (note: not all forms of epilepsy present this way; there's generalized epilepsy, complex partial & simple partial, absence seizures, etc...), promptly drowning (perhaps before your dive buddy even notices you're unconscious).

In theory (& I have no idea whether this has ever been tested), a diver in a full face mask who lose consciousness would continue to breathe until he/she ran out of air, which would give a dive buddy much longer to notice and get that person to the surface.

Now, someone who wants to be an instructor & demonstrate octo. use, mask clearing and so forth may not find using a FFM during instruction to always be practical. But of a recreational diver, well, let me put it this way; if I developed epilepsy and my doctor got it under control with medication but there was still some risk, I'd probably try a FFM. I'm not advising anybody else to do this; just sharing an idea.

Richard.

http://www.scubaboard.com/forums/diving-medicine/2741-diving-epilepsy.html

http://www.scubaboard.com/forums/basic-scuba-discussions/255831-infrequent-blackouts-still-scuba.html

http://www.scubaboard.com/forums/instructor-instructor/241435-epilepsy-issue.html

http://www.scubaboard.com/forums/introductions-greets/230540-diving-epilepsy.html

http://www.scubaboard.com/forums/diving-medicine/225246-brain-seizure-activity-diving.html

http://www.scubaboard.com/forums/diving-medicine/4848-diving-epilepsy.html

http://www.scubaboard.com/forums/diving-medicine/87363-epilepsy-diving.html

http://www.scubaboard.com/forums/diving-medicine/158487-diving-seizure-disorder.html

Can has been opened many times before, But the simple answer is still the same, if there are active seizures or a risk of them they shouldn't be diving.

I'm a new diver, AND I SUFFER FROM FREQUENT SEIZURES!

It's vitally important to first understand that not all seizures are like what you see in the moves, and in fact, most are not. My physician is a very active diver, and he had no problem signing off on my medical release in order for me to begin working on my OW Cert.

I suffer from Hemiplegic Migraines, which is a disease that consists of migraines which are off the charts. My migraines cause frequent seizures and stroke like symptoms and even actual mild strokes.

My seizures however, are "absence seizures", which is most similar to drifting off into a daydream for anywhere from as little as a second or two and up to a minute or so in the worst case scenario. Mine generally last just a few seconds, and the only actual effect is absolute lost time. I'm not on any medications any longer, because honestly I quit taking them! The meds caused far more much worse side effects, and greatly reduced anything even remotely close to being able to be referred to as "quality of life". I can have a dozen seizures a day, and have many times, and I also know to take it easy for a couple of days following them. On the flip side however, I may go weeks or months without one, which is quite nice! The one year post seizure thing isn't gonna happen for me, but I might wait a day if I haven't traveled to dive. I've had to change a few things in my life, and quitting rock climbing was the biggest one, but life it what it is...

The vast majority of Epileptics that I know have the same type of seizures that I do, and it's not a problem for them either.

As with anything else that often falls into a "delicate" classification, the diver needs to be forthright with any potential partners and/or students, and let them decide for themselves.

The funny thing is, my instructors own wife sufferes from the same disease as I do, and he is unable to get any info from local doctors... Once he read my medical waiver, he began quizzing me in depth, and then he let me know why. I provided him with a ton of info, including specific doctors who his wife should consider seeing. Again, he's an instructor that wants to get his own wife in the water!

-Tim

It isn't black and white. Well managed epilepsy might bring the risk level down into the range of all other risks, so diving would be OK. But it makes sense to have a different risk standard for a DM or instructor vs a recreational diver.

If we liken it to driving, someone might be qualified to drive a personal car but not a bus full of passengers.

Hi. I am a very new diver, just got certified recently (this is my first post on this board as a matter of fact) and I have had Epilepsy since 1989. My doctor signed off on the medical form with no problem. I have not had a seizure in over 5 years and I drive (no DMV issues). The seizures that I have had in the past are grand mal seizures (the ones you see on TV) but I do take two medications to control them. They are clearly very well controlled and have been for a very long time now.

As a matter of fact, I actually was hired by a local police agency and went through the police academy (off topic I know) but the medical for the police academy didn't have a problem with the seizures either.

I obviously have no problem diving with Epilepsy if the seizures are as controlled as mine are AND if I tell those who I dive with that I have Epilepsy so they are well aware and they are comfortable going with me.