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Epilepsy

Old 29th Jul 2008, 17:24
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Epilepsy

Can someone help me with this medical issue.

Over a year ago I was diagnosed with Epilepsy (complex partial seisures) which in laymans turns mean I occasionally fall over. Now I know what you are thinking this is not a good thing if you are behind any sort of aircraft!

I have now been drug controlled for over a year and have my driving licsence back but I would like to know if I could realistically go for my PPL.

My understanding is that after a year I am entitled to fly under instruction of with another qualified pilot but I would love to hear from someone who has first hand experience of this.

Last of all has anyone out there managed to get past a class one medical with this condition, even if it has taken ten years?

Many thanks

Andy
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Old 29th Jul 2008, 17:50
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Unhappy simple answer . . . . . .. . .

but I would like to know if I could realistically go for my PPL
NO

after a year I am entitled to fly under instruction of with another qualified pilot

NO

has anyone out there managed to get past a class one medical with this condition
NO


Sorry if this is not what you had hoped to hear, but (at least here in the UK ) this is absolutely 100% and non-negotiable.

Last edited by AMEandPPL; 29th Jul 2008 at 18:03.
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Old 30th Jul 2008, 00:14
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Red face this forum is world wide - just to be 100% accurate . . . . . . . .

but (at least here in the UK ) this is absolutely 100% and non-negotiable
It should also be mentioned, in order to be completely fair to all, that some other countries' rules are nowhere near as proscriptive as ours. We have, for example, read on here in recent times of professional pilots on anti-depressants and other psycho-active medications.

Presumably those same countries will be just as liberal in their approaches to epileptic, or perhaps even blind, pilots.

The UK standards are firm, fair, sensible, and long-lasting.
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Old 30th Jul 2008, 03:10
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Epilepsy and abnormal EEG are a cause of Permanent unfitness for aviation duties all licences as per ICAO, FAA, DGCA - all countries.
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Old 30th Jul 2008, 08:40
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Okay so far the reponses seems to be on the same line however can someone explain this document from the CAA site. It gives similar guidelines for driving and seems to give the impression that there is hope!

http://www.caa.co.uk/docs/49/SRG_Med-NPPL_epilepsy.pdf

I think my best move is too contact the CAA for clarification.

I know that for people reading this the notion of a pilot with Epilepsy may seem absurd but its a condition that when treated correctly will hopefully never bother me again. I am able to drive again and lets face it if you take the amount of time I spend in a car compared to what you could as a pilot I suspect I pose a far greater risk in the car.

Its been over a year since I have had a problem and I dont really care if I have to wait another ten years, at some point I want to fulfill my ambition to get my PPL!
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Old 30th Jul 2008, 10:21
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Unhappy not the same as JAA . . . . . . . .

can someone explain this document from the CAA site
The page you have found refers to the rules applying to the issue of an NPPL (National Private Pilot's Licence), not any form of JAR licence.

For an NPPL no JAR medical is required; the standards applied are those applied by the DVLA for drivers, either HGV or ordinary cars. Under those rules an epileptic MIGHT be allowed to fly light non-complex types of aircraft after being proven to be fit-free and well-controlled for at least three years.

Let me re-iterate, epilepsy is a TOTAL BAR to any form of JAR medical certificate.

This is, perhaps, not completely the right place for a full discussion on this topic, but many believe that the NPPL is an outrageous example of double standards. If, under the prevailing legal rules for all other pilot certification in the UK ( ie the JAR regulations) , Mr X is not deemed "fit to fly" for whatever reason at all, then how can it be justified that he is allowed to fly the same machine, in the same airspace, but simply under a different set of rules ? ? It makes a mockery of the whole concept of "regulation". Also makes a mockery of "safety".

Yet the department responsible for this is, wait for it, the
"SAFETY REGULATION GROUP" ! !

Finally, two more points for you to consider. Fits are often (though not always) triggered by "photic stimulation" (flashing or flickering lights).
The risk is extremely high from sunlight being flickered through a rotating propeller disc. Secondly, many epileptics get a brief warning that a fit is about to occur. Not very long, but could just be long enough for a driver to stop, or pull onto the hard shoulder. Now in the case of a pilot cruising at 3000 feet, maybe even over water . . . . . . . . . . .

Hmmmm - I'm not at all happy about any of this
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Old 30th Jul 2008, 17:11
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AMEandPPL,

I see your point, but...

Safety is a risk-based thing, not absolute.

Higher risk would be (say) an undisclosed drug-controlled commercial pilot flying passengers, who occasionally forgets to pop the pills.

Lower risk would be (say) the NPPL wannabe, who just wants to do a few hours a year solo or with family, who happened to have the magic second seizure (that makes him/her diagnosed an eplilepsy sufferer for life) two decades ago without further recurrence or drugs prescribed...

I think the SRG have it about right, as long as the medical professionals do their job, according to the rules - what do you think about that range of cases?
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Old 30th Jul 2008, 17:15
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First of all thanks for the info, that does make things a bit clearer.

I do agree that having a variety of rules does seem to complicate matters which is not good for anyone, however these issues are never simple and I do not subscribe to ruling out anyone who has a medical condition from flying.

I know epilepsy understandably would strike fear into most people if they thought we were at controls of a 747 day in day out but it simply not like that. Many people are put on medication and that is the end of it. They never have another black out or fit or aura for the rest of there life.

I do not think we should be precluded from activities such as flying if a doctor believes that the risk of a fit is no more that what over people may encounter. What about an overweight person having a heart attack or even someone over fifty who has smoked for all their life. Why should we be treated differently than others who pose just as great a risk?

Incidentally I believe its about 20% of people with epilepsy that are sensitive to light and flashing.

Thanks for the info, I think this is a pretty good place for a discussion and I am intrigued to hear peoples opinions.
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Old 30th Jul 2008, 18:14
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Red face where are the lines to be drawn . . . . . . . . . ?

This is likely to be a very interesting debate ! Yes, of course I can see all that. The division between high and low risks, the concept of the epileptic PPL pleasure flier, the hope that control remains good for ever, etc etc. If the DVLC can allow epileptics to drive, then why can the JAA not allow them to fly ? I suggested two reasons in my earlier post.

Let me just make it clear that right now all I am doing is upholding, and explaining some of the thinking behind, the rules as they presently are.
JAR medical regulations are enshrined in the Air Navigation Order, which in turn is part of the law of the land. Just as clear as the laws against murder, or speeding ! I am in favour of the rules which are in place being adhered to, until they are changed. There could, of course, be a debate about whether a better, fairer, set of rules could be drawn up.
But, as always, the line needs to be drawn somewhere !

Rules do vary in different areas (ie countries). Some countries now allow insulin-dependent diabetics to be pilots, though it is still 100% forbidden here in UK, and in my younger career I was taught that this was heresy !
Similarly, as has been mentioned on this forum before, some countries now allow commercial pilots (yes, class 1's ! ) to take mind-altering drugs such as anti-depressants. That is also out of the question in the UK and Europe at the present time.

I personally believe that the introduction of the NPPL allowed quite outrageous double standards to exist. Same aeroplane, same airspace, same pilot, maybe even same passengers ! x = fit , y = unfit. How can this exist in one country ?

Enough of a rant from me . . . . . . any more from others ?
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Old 30th Jul 2008, 18:52
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Over here the FAA has the same rules for seizure disorders ("epilepsy" is a lay term!) and does not allow even a third class.

The way I've had this explained is that the FAA would be willing to change the rules for things like long term medication-controlled seizure disorders, antidepressants, and the like. However they require that the medical profession guarantee that the condition will not be incapacitating at some time in the future, and of course no such guarantee can be given, because there is no objective measurement which will accomplish that. They've approved a few diabetics at least for third class, but the hoops required are considerable, and there are some tests which can be used
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Old 1st Aug 2008, 06:35
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We have, for example, read on here in recent times of professional pilots on anti-depressants and other psycho-active medications.

Presumably those same countries will be just as liberal in their approaches to epileptic, or perhaps even blind, pilots.
OT. Can not let this pass in fairness to all the PROFESSIONAL aircrew out there who are making a valuable contribution for the good of all and are no more likely to do something untoward than any other, and the Australian aviation medical fraternity who support them. A clinical assessment is made by a board of experts at the licensing authority and each case is judged on its merits, just as it is with an individual with heart difficulties. The swipe you take in your post towards the Australian authorities is uncalled for and have yet to see any rebuttal of the study they have made on this issue. I have a feeling that you may be some what close minded on examining the issue. Like pilots, the medical profession can be very conservative and unwilling to grasp new concepts and thinking. Witness the difficulty Barry Marshall of the Western Australia's Fremantle Hospital had in convincing the fraternity that most stomach ulcers were caused by Campylobacter like bacteria (Helicobacter pylori) and treatable with antibiotics. The Lancet rejected the publishing of his findings but he did end up with a Nobel Prize for his work. Your advice is much appreciated by all, but please lets be a little more forward looking and open to the notion that the Belgrano is not the font of all wisdom.
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Old 1st Aug 2008, 07:55
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AMEand PPL -I think you will find that the UK standards have changed. Visual acuity standards have changed. Pilots are permitted to fly following myocardial infarction, coronary artery bypass grafting, or even heart transplantation. EEGs are no longer required for initial screening as the evidence was not there for them (you remember evidence based medicine don't you). There is a lot of work being done by the CAA medical authorities regarding colour vision requirements as well. The "1 percent rule" is also under review. Just because a rule is long-standing, does not mean that it is still applicable or best practice. If it was, we would still be using leeches.

Your constant denigration of the Australian authorities, just because the way they do things is different to what you learned "back in the day" is offensive, and reeks of ignorance and snobbery. The Australian authorities do not allow the certification of epileptic nor blind pilots. However, if they did, it would be done on a sound analysis of the current evidence, the risks of sudden or subtle incapacitation, and with wide consultation. Decisions are not made on the mindless basis of "that's the way it's always been" or "we must do what the Brits do because they are the only ones who know what they are doing".
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Old 1st Aug 2008, 09:48
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Unhappy thanks for those . . . . . . . . .

Comments noted. No surprises there.

Let me just make it clear that right now all I am doing is upholding, and explaining some of the thinking behind, the rules as they presently are.
Most of the queries I have answered here in recent months (not all, it's true, but certainly most) have come from young aviation aspirants in the UK, so the advice and answers given have reflected the rules and standards currently being applied here. If and when those change, then advice and answers would obviously also change.

I have not named any individual countries for several months, just referred to the fact that elswehere things are done differently to here.
I was previously severely ticked off by the moderators for referring to specific countries, so I have refrained from doing so any more. How you interpret "elsewhere" or "other countries" is up to you, but I have not pointed fingers in any specific direction at all.

Finally, and on a purely personal note , I should say that I still strongly agree with the aviation medical standards laid down and implemented by the UK and the JAA community. I feel in safe hands when I or my family board a commercial flight in Europe. In many other parts of the world (note the words) I know I would feel some apprehension.
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Old 1st Aug 2008, 10:59
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Quote from andy sp:
Its been over a year since I have had a problem and I dont really care if I have to wait another ten years, at some point I want to fulfill my ambition to get my PPL!

I can only write as a retired commercial pilot and father of one epilepsy sufferer; not a medical practitioner. There must be types and degrees of the condition, I suppose, and treatment may be more effective in some cases than others. Since stabilised on medication, have you had an EEG? If so, was it a 24-hour one?

Understandably, you have given few details of your condition. We don't know if you've ever had a tonic-clonic ("grand-mal"), or what your complex partial seizures ("absence seizures", or "petit-mal") are like. On an EEG, my daughter's seizures could be triggered by hyper-ventilation, not by strobe effects. As a child, she used to have as many as 10 per hour at her worst, each lasting about 30 - 60 seconds, but she never fell over, as you say you do. She used to ride a bicycle, and never fell off. But in later years, well established on the latest medication, there were indications that she was still suffering very short-duration seizures that produced a lack of ability to concentrate.

You talk of waiting ten years if necessary. My daughter was stabilised on medication which seemed to have stopped her tonic-clonics completely. Then, after a period of over 9 years, she had two in a day, with little warning. Previously, at her worst, she'd never had more than one a month; always within an hour of waking.

In my very narrow experience as a lay person, Epilepsy seems to be unpredictable, and manifests itself in many forms.

Forgive me saying that, if I was a flying instructor, I'm not sure I'd want even to take up a student who, in the event of an unexpected tonic-clonic, might present me with full right rudder that I'm not strong enough to counter.
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Old 1st Aug 2008, 13:00
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Smile totally agree . . . . . . . . . .

Forgive me saying that, if I was a flying instructor, I'm not sure I'd want even to take up a student who, in the event of an unexpected tonic-clonic, might present me with full right rudder that I'm not strong enough to counter.
Thank you, Chris ! Could not have put it better myself !

Thanks also for the observation that once the risk is known to be there, the number of years that pass by is almost immaterial.
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Old 20th Aug 2008, 23:04
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I'm sorry but I cannot believe the prejudice and false information on this thread. I just hope that those writing do not suddenly find themselves on the floor not knowing what happened, only to learn that they have to immediately stop driving and flying.

I understand the JAA medical rules are designed to reduce the risk of incapacitation to below 1%.

The NPPL medical is a sign off by your GP who knows your medical history and is probably much more accurate in determining your future risk as a pilot than the rather pathetic 2nd class medical I remember having.

Basically if you are judged as fit to drive a car then you can fly on a restricted NPPL. Yes, terrible isn't it, practically the same capability in the same airspace as all those other pilots who are supposedly fit. If you have a diagnosis of epilepsy this will be determined after a comprehensive series of tests and probably the precaution of taking an anti-epileptic drug. After a year with no problems, sure some risk remains but the risk of a problem occurring over maybe 50 hours of flying a year is minimal.

Thank goodness I had a sympathetic flying instructor and a CFI who persuaded me not to give up flying!
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Old 21st Aug 2008, 04:00
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andy_sp, I was diagnosed with epilepsy (tonic clonic) 20 years ago. My neurologist immediately informed an assortment of authorities and I lost my pilot's licence and my driver's licence. I also lost my potential job. Took me 5 years to come to terms with the loss. I regained my driver's licence after 2 years of being seizure free, but am unable to legally obtain employment as a driver in Australia (can't even drive a truck or a taxi). I've been seizure free now for 18 years BUT each time the EEG is done, the neurologist tells me the prognosis is "poor" and I am unable to risk coming off my meds. These days I sit in the right hand seat of a Mooney (my partner sits in the left seat). Like I said, took me 5 years to come to terms with the loss, but these days I do enjoy being the professional passenger.

I'd recommend a chat with your neurologist and/or a general practitioner about your condition and the very real risks it still imposes. When I was first diagnosed they handed me this long list of things I was no longer allowed to do and I almost died! No swimming, no baths unless supervised, no bushwalking, no climbing, always shower with the door open and only when someone else is at home. But life is about risk assessment and these days I do a lot of things on my own that it's recommended I don't. BUT I won't and would never consider trying to regain my pilot's licence. As mentioned by others, the risk of a tonic clonic and a full right rudder .... even if you flew with a fellow pilot, there's no way they'd be able to counteract the sheer strength of your muscles in full seizure mode.

Yes, I am aware that even by sitting in the front right seat I am taking a risk. But I'm very short, the seat is all the way back and I can't reach the pedals.
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Old 18th Nov 2008, 09:25
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Advice kindly requested!

Hi All,

My name is Matt Avery, I'm 23 years old and British. Firstly, I'd like to apologise for the inevitable length of this post, but thanks to all who read it as your advice will be much appreciated.

When I was 18 I was all "ready to go" on Oxford's ATPL training programme (zero to ATPL). However, when I took my Class 1 medical I had a couple of blips on the EEG (electrodes on head) that needed to be referred to further neurologists. After a few weeks my application was rejected on the grounds that I may have a 3-4% higher chance of epilepsy than the average person (I have no family or personal history of epilepsy). They issued me with a Class 2 certificate, but my choices were to either appeal and I guess get another consultant to check me over and if fine appeal to the CAA, or to leave a resonable amount of time (say 3 years) and come back to try again. I studied for a degree and am now in full-time work. This year I contacted the CAA to take my Class 1 medical again, and they told me I can't do so based on the previous case. This is despite the fact that they have dropped the EEG on Class 1's and is no longer a requirement.

Without wanted to sound dramatic, being a pilot has been my dream since I was a kid & I wondered if anyone out there has any advice? I am very phsyically active and go to the gym 4-5 times per week, so I know I would say this but I personally believe I'm physically able to fly a plane.

If anyone has advice on how I should take this forward I'd really appreciate your input.

Kind regards,
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Old 18th Nov 2008, 10:13
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Hello Mattuk1

I'm sorry to hear about your problems gaining a Class 1 medical certificate. While I don't profess to have any particular knowledge on the requirements/restrictions relevant to your case, you should be aware that the European Aviation Safety Agency will be taking control of pilot medical requirements in the near future and are currently consulting on the details. A Notice of Proposed Amendment (NPA) has been published on EASA's website. The link is http://www.easa.eu.int/ws_prod/r/doc...202008-17c.pdf

The relevant section is reproduced below. It would appear that if you can't gain an unrestricted Class 1, you could at least get a multi-crew restricted Class 1, which would mean you could fly multi-crew operations. The caveat to this is that I am no expert on the subject, but reading the details below suspect you have more than a fighting chance of achieving your goals. I wish you the best of luck.

Jez

AMC A to MED.B.060
NEUROLOGY class
1 medical certificates


1.
Epilepsy
1.1. A diagnosis of epilepsy is disqualifying, unless there is unequivocal evidence of a syndrome of benign childhood epilepsy associated with a very low risk of recurrence, and unless the applicant has been free of recurrence and off treatment for more than 10 years. One or more
convulsive episodes after the age of 5 are disqualifying. In the case of an acute symptomatic seizure, which is considered to have a very low risk of recurrence, a fit assessment may be considered.


1.2. An applicant may be assessed as fit with a multipilot limitation if:
(i) there is a history of a single afebrile epileptiform seizure;
(ii) there has been no recurrence after at least 10 years off treatment;
(iii) there is no evidence of continuing predisposition to epilepsy.


2.

Conditions with a high propensity for cerebral dysfunction
An applicant with a condition with a high propensity for cerebral dysfunction should be assessed as unfit. A fit assessment may be considered after full evaluation.


3.

Clinical EEG abnormalities
3.1. Electroencephalography is required when indicated by the applicant’s history or on clinical grounds.
3.2. Epileptiform paroxysmal EEG abnormalities and focal slow waves should be disqualifying.


4.

Neurological disease
Any stationary or progressive disease of the nervous system which has caused or is likely to cause a significant disability is disqualifying. However, in case of minor functional losses associated with stationary disease a fit assessment may be considered after full evaluation.


5.

Episode of disturbance of consciousness
In the case of a single episode of disturbance of consciousness, which can be satisfactorily explained, a fit assessment may be considered.


6.

Head injury
An applicant with a head injury which was severe enough to cause loss of consciousness or is associated with penetrating brain injury should be reviewed by a consultant neurologist. A fit assessment may be considered if there has been a full recovery and the risk of epilepsy is sufficiently low.


7.

Spinal or peripheral nerve injury
An applicant with a history or diagnosis of spinal or peripheral nerve injury should be assessed as unfit. A fit assessment may be considered if neurological review and musculoskeletal assessments are satisfactory.


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Old 18th Nov 2008, 10:25
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Don't give up until you've exhausted all avenues, even if it costs you a few quid.

If I were you, I'd speak to your local AME - they will know how the CAA medical division works and give you some sound advice.
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