Can I get a Medical Class 1 (EASA) after a brain tumor?
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Can I get a Medical Class 1 (EASA) after a brain tumor?
Hello everyone.
As I was six years old, I got diagnosed with a brain tumor. To be exact, it was and still up to this day is not clear if it is a zyst or a brain tumor (in the left mediotemporal cortex with perifocal gliosis) but it never was considered one of the bad types. Back then the doctors considered it to be either a malformation tumor or a low-grade gloomy. I also never had any complications or problems with it. Initially it was found after checking my brain because I did sleepwalk.
It was in constant monitoring for ten years and never something really happened. Last year, 13 years after it was first diagnosed, I did a new MRT for my medical class 1 examination.
The pictures showed, that the tumor is gone and that there is only a slightly visible scar on where it was.
Now, the medical examination went great and I would have gotten my medical if it would not have been for my medical history. So the doctor did send the case to the German Federal Aviation Office (LBA). This was about a year ago. They could not decide about my airworthiness so they did refer me to an external medical expert neurologist. I was there in August this year and already received his recommendation which was also sent to the LBA.
He did pronounce me unfit to fly, for all classes. His recommendation was entirely positive up to the point where he did argue that there would be a potential higher risk for epileptic seizures and that this would be the sole reason he denied my airworthiness. He did not do an EGG scan (he said because the scar was in the medial temporal lobe, that there would not be any changes to expect) or anything else than looking at and comparing the pictures I did send him and the usual neurological tests. I would not want to put anyone at risk ever, so I understand his perspective that he thinks this would be the ending already. But I do not want to give up.
As I read that letter, it sure felt like someone did hit me real hard and even now I cannot say that I do not feel grief and despair. I try to stay optimistic because the LBA has yet to check and confirm or deine his recommendation but it feels hard sometimes. How can this diagnose, which feels so final, turn around to the good? I really want to fly and I can say that I already buried my heart in aviation. I never had any (epileptic) seizures so I feel remorse that the case might be decided on something that will never happen.
If you read till here, I want to thank you. What can I do to prove that I am medically fit to fly? Is there even a chance to turn this around? Does anyone of you have had similar experiences?
I would be so grateful if anyone could share their insights or some advice with me. It would mean the world really.
Warm greetings,
WhiteWidow
As I was six years old, I got diagnosed with a brain tumor. To be exact, it was and still up to this day is not clear if it is a zyst or a brain tumor (in the left mediotemporal cortex with perifocal gliosis) but it never was considered one of the bad types. Back then the doctors considered it to be either a malformation tumor or a low-grade gloomy. I also never had any complications or problems with it. Initially it was found after checking my brain because I did sleepwalk.
It was in constant monitoring for ten years and never something really happened. Last year, 13 years after it was first diagnosed, I did a new MRT for my medical class 1 examination.
The pictures showed, that the tumor is gone and that there is only a slightly visible scar on where it was.
Now, the medical examination went great and I would have gotten my medical if it would not have been for my medical history. So the doctor did send the case to the German Federal Aviation Office (LBA). This was about a year ago. They could not decide about my airworthiness so they did refer me to an external medical expert neurologist. I was there in August this year and already received his recommendation which was also sent to the LBA.
He did pronounce me unfit to fly, for all classes. His recommendation was entirely positive up to the point where he did argue that there would be a potential higher risk for epileptic seizures and that this would be the sole reason he denied my airworthiness. He did not do an EGG scan (he said because the scar was in the medial temporal lobe, that there would not be any changes to expect) or anything else than looking at and comparing the pictures I did send him and the usual neurological tests. I would not want to put anyone at risk ever, so I understand his perspective that he thinks this would be the ending already. But I do not want to give up.
As I read that letter, it sure felt like someone did hit me real hard and even now I cannot say that I do not feel grief and despair. I try to stay optimistic because the LBA has yet to check and confirm or deine his recommendation but it feels hard sometimes. How can this diagnose, which feels so final, turn around to the good? I really want to fly and I can say that I already buried my heart in aviation. I never had any (epileptic) seizures so I feel remorse that the case might be decided on something that will never happen.
If you read till here, I want to thank you. What can I do to prove that I am medically fit to fly? Is there even a chance to turn this around? Does anyone of you have had similar experiences?
I would be so grateful if anyone could share their insights or some advice with me. It would mean the world really.
Warm greetings,
WhiteWidow
Last edited by WhiteWidow; 25th Oct 2023 at 17:10. Reason: Update in case
I suspect your situation is rare, leaving a paucity of statistical data that would establish seizure risk.
It may well be that your seizure risk is no more than the general population, but aviation medical authorities are highly risk adverse.
Possibly another jurisdiction would be more open minded. Perhaps your national pilot association can be of help. AOPA in the US has an aeromedical panel. It may be worth taking out a membership to access their expertise. That said, there are conditions that preclude obtaining a medical anywhere.
It may well be that your seizure risk is no more than the general population, but aviation medical authorities are highly risk adverse.
Possibly another jurisdiction would be more open minded. Perhaps your national pilot association can be of help. AOPA in the US has an aeromedical panel. It may be worth taking out a membership to access their expertise. That said, there are conditions that preclude obtaining a medical anywhere.
I assume you never had a biopsy so the tumour or cyst is undiagnosed but if is now just a scar it was likely a cyst. A scar does increase the risk of a fit but in very general terms the longer you go without a fit the less the risk. After 14 years with no fit the risk of a first fit must be infinitesimal. Children are more likely to have early onset fitting if they fit and late onset is rare even though you are now an adult. Precipitating factors include loss of consciousness and amnesia both of which I suspect you never had. Finally the risk was greater when you had a space occupying mass than now when there is just a scar. That is why you are not on antiepileptic drugs and I presume you are allowed to drive. However I cannot find any hard data on the risk of a fit after 14 years!
So much for the science. You now have the issues of the neurologist. What expertise does he have in aviation medicals? I presume he is has paediatric experience because you were a child and the pathology is specific to children....What question has he been asked or think he has been asked? ........ I have no knowledge of your regulator but most want the risk of a fit below x and I think there is a good chance you are below x.
I would go back to the neurologist and ask 1 what level of risk of a fit is acceptable to the regulator? (he should say 1 in x and if he doesnt he may not know!!).
2 what is my level of risk of a first fit?
Only when you have hard facts can you challenge eg by getting another opinion or posting back here and we will try to guide you
So much for the science. You now have the issues of the neurologist. What expertise does he have in aviation medicals? I presume he is has paediatric experience because you were a child and the pathology is specific to children....What question has he been asked or think he has been asked? ........ I have no knowledge of your regulator but most want the risk of a fit below x and I think there is a good chance you are below x.
I would go back to the neurologist and ask 1 what level of risk of a fit is acceptable to the regulator? (he should say 1 in x and if he doesnt he may not know!!).
2 what is my level of risk of a first fit?
Only when you have hard facts can you challenge eg by getting another opinion or posting back here and we will try to guide you
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Thank you for your valuable input Radgirl. You are right, I never had a biopsy done nor did I have the need to take in any drugs nor had any symptoms, The neurologist who made this argument was PD Dr. med. Frank Weber. He is a specialist for neurology, aviation medicine, psychiatry and psychotherapy as well as some more subjects. He is well known in what he does and used to work for the German Luftwaffe.
He did ask questions about my family and any occurrences of symptoms with me and my family. He did look at all of the scans made from my brain and had all the papers and information. Yet he did not give me any numbers like you mentioned. In the report he sent to the LBA, as I mentioned, he only wrote a very positive assessment about me (he did do a lot of psychoanalyzing too and asked me about my career and how I will finance my pilot training) and in one sentence stated, that „even though the patient remained seizure and symptoms free till now“ he disregards that and insists on his assertion.
I will send him an email, asking him about the exact numbers.
He did ask questions about my family and any occurrences of symptoms with me and my family. He did look at all of the scans made from my brain and had all the papers and information. Yet he did not give me any numbers like you mentioned. In the report he sent to the LBA, as I mentioned, he only wrote a very positive assessment about me (he did do a lot of psychoanalyzing too and asked me about my career and how I will finance my pilot training) and in one sentence stated, that „even though the patient remained seizure and symptoms free till now“ he disregards that and insists on his assertion.
I will send him an email, asking him about the exact numbers.
It might be useful to contact the hospital where your operation was done. While samples of the removed tissue are less likely to be available after some 15 years, there may be a histology report in the hospital records. I would be surprised if histology was not done.
Whether a favorable histology report would sway the opinion of the neurologist is another question.
Whether a favorable histology report would sway the opinion of the neurologist is another question.
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It might be useful to contact the hospital where your operation was done. While samples of the removed tissue are less likely to be available after some 15 years, there may be a histology report in the hospital records. I would be surprised if histology was not done.
Whether a favorable histology report would sway the opinion of the neurologist is another question.
Whether a favorable histology report would sway the opinion of the neurologist is another question.
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I just contacted the neurologist who recommended me unfit to fly and I he said, that intracortical lesions carry an increased risk of seizures. He said that, like in his expert opinion, this increase i risk is difficult to quantify (so no numbers here). He also could not tell me what risk the LBA accepts and that it must be put to them. He also said, that over time the probability of remaining seizure-free changes and gave an example of what would happen with an assumed risk of 1 % per year. For the 14-year period this would mean a risk of 0,87%.
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.... The neurologist who made this argument was PD Dr. med. Frank Weber. He is a specialist for neurology, aviation medicine, psychiatry and psychotherapy as well as some more subjects. He is well known in what he does and used to work for the German Luftwaffe.
.....
I will send him an email, asking him about the exact numbers.
.....
I will send him an email, asking him about the exact numbers.
Last edited by Memphis Hubert; 29th Sep 2023 at 13:22.
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Hi Hubert, I finally was able to read your pm but unfortunately I can’t reply to you since I am new here. I will continue to post so that the restrictions may lift.
Since I can not pm you atm, is it possible to reach out to you on another platform where I could send you the e-mail?
Since I can not pm you atm, is it possible to reach out to you on another platform where I could send you the e-mail?
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Hi Hubert, I finally was able to read your pm but unfortunately I can’t reply to you since I am new here. I will continue to post so that the restrictions may lift.
Since I can not pm you atm, is it possible to reach out to you on another platform where I could send you the e-mail?
Since I can not pm you atm, is it possible to reach out to you on another platform where I could send you the e-mail?
