Loss of Class One Medical - Seizure
 

Hi,

Cutting a very long story short, at the end of 2022 I had a provoked seizure which was caused by a third-party factor. I've never had a seizure before in my life and also in my families history. For this seizure, I saw a professor in neurology earlier this year who deemed my recurrence of another seizure to fall below 1% in the next 5 years..! I am not on any medication at all. Having no knowledge of medical literature or knowledge before, when my AME sent all documents to the CAA for processing because I wanted an answer, they have picked up on this seizure thing and have essentially said 'Thanks, but re-apply in 5-Years time'. There are various other things to this, but naturally this has really dented me personally and mentally. I was wondering if anyone here has had a provoked seizure of any sorts and have managed to either reduce the wait time and/or get a successful second opinion?

I wasn't offered to see a CAA neurologist (unless the one I saw was..?) and I've never been through this before and/or carried out an appeal. I'm single, 31, no dependents and flying is something that I've wanted to do since a very young age. But, equally, I have lots of other passions and interests..

Your assistance and any advice/guidance would be most appreciated. Thank you so much.

My sympathies to you. I would write to the CAA and request a meeting with their neurologist.

Just out of interest, do you eat foods and drinks containing Aspartame, (an artificial sweetener), or other artificial sweeteners?

Thank you for your suggestion, I will bring this up with my AME. I received the outcome letter at the end of September and quite frankly, as I said, it really surprised me that they did not offer any more guidance at all and if I'm being brutally honest I do feel somewhat very lost in the process.

Regarding the Aspartame, I wouldn't have a clue as I've never heard of it before, but generally I do have quite a sweet tooth! I'm now actively trying to look at what I eat to better improve my life and the way I feel.

The UK CAA seem almost "Elizabethan" in their approaches. Sad that you have to involve them at all. Surprised they didn't communicate and instead suggest a "course of leeches, and reapply in 5 years". :ugh:

A friend had a seizure during chemotherapy over ten years ago and none since. Transport Canada remains obdurate.

I don't know why, but the UK CAA have been very weird in recent years. The last time I went there in person with all my documents for a new type rating; they were positively rude to my face, for absolutely no reason. (I am a polite and pleasant guy).

Yes, definitely check food labels. Many products use artificial sweeteners such as Aspartame to avoid putting actual sugar in, so they can claim 'low calories'. But years ago I read a first hand account of a person who had had a seizure, and artificial sweetener Aspartame was strongly implicated as the cause.

I also knew a person who used a lot of artificial sweeteners in their cups of tea, who degenerated into dementia.

Circumstantial, but I personally do not take the risk, and I reject any food or drink containing these chemicals. The brain runs on sugar as its power source, and maybe the introduction of artificial sugar chemicals interferes with its functioning.

I would suggest in these days that you are better off not telling the CAA anything unless you have to.

I wonder why no one provided PT92 with the relevant links to the CAA, containing all necessary information: https://www.caa.co.uk/aeromedical-ex...e-material-gm/

2 points to consider: 1 seizure does not (yet) constitute "Epilepsy". So after the one seizure the causation has to be investigated. If the "third party factor" can be identified and this "causation" can be avoided in the future with the effect, that without that the risk of another seizure is the same as of any normal person, there is no reason to reject the class 1 medical.
For example of what is an avoidable causation and what not: Drugs § Alcohol are avoidable, while hyperventilation and strobe lights (like used in EEGs with provocation) are not avoidable, because they're part of daily life.

EASAs AMC1 MED.B.065 Neurology (which CAA's regulations are based on) says following:
.....
"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 after neurological evaluation"
.....

"acute symtomatic seizure" is to be used instead of the older "provoked seizure", and means there has been, what PT92 calls a "third party factor".

These arguments should be used at the CAA.

The FAA requests 1 year "recovery" after one seizure, even if provoked. Check the document Guide for Aviation Medical Examiners - SEIZURE . It says everything which is usefull and necessary.

Hi Memphis Hubert,

Thank you for this, most appreciated. I also have seen the EASA regulations regarding the neurologist and agree with you about the 'Acute Symptomatic Seizure' bit, and would agree with you. I just don't understand why the CAA have not asked me to come and see their Neurologist... The seizure was provoked and by a 'Third Party Factor', so what do I do now? Apologies, but I am a little lost sometimes with this..

I am sorry the CAA has not communicated more comprehensively but you have had two seizures so I am not surprised they are not happy. Without knowing what caused the second seizure it is impossible to give you further advice as some triggers may or may not potentially recur. You need to inform them of your full history if you have not already done so, and ask what you need to achieve a) to obtain your medical within the 5 years and b) what you need to demonstrate at 5 years. There is no point wasting money on seeing doctors if the regulator is intransigent.

Hi, thank you very much for your input. I do apologise though, as I’m unsure where I’ve stated I had two seizures? I have definitely had one, single, provoked seizure.

Hi PT92,

I'm not familiar with the UK-CAA and how they deal with such matters. However their regulations are still more or less EASA-like, so are the regulations about seizures.
What I can tell you of EASA-CAAs - they usually don't send you to doctors when having been referred, only when you applied for a Second Review. It is up to you to prove them that you're fit to fly. I would therefore suggest that you check yourself for a neurologist, who is widely accepted by the CAA. For this contact your AME or AMC (Heathrow, Gatwick), may be they can help you further.
Once your CAA has a document telling them that the probability of another seizure is the same as with normal unaffected people with the trigger being easily avoidable, they should usually reissue the medical class 1 again, probably with OML.

Hi, I am still investigating this and pushing this forward with my AME to gain a second opinion, but it's a slow journey so far with other external factors going on. Would you say that the Neurologist I saw did provide a judgement regarding another seizure being below 1% in 5-years time, and this 1% rule is taken from the ICAO Manual of Civil Aviation (Chapter 3) as detailed in the CAA's letter to me.

My question is, can things be turned around and changed given this rule is written by ICAO? I don't mean to say change ICAO's rules.. not for one minute. But what I'm trying to get at is how you get from below 1% in 5 years time to.. The risk of another seizure is that of a normal person.

All I want is my medical back and my life back to some-sort of 'normal' whatever that is. The seizure was driven by medication I took, as prescribed to me by a GP, which I am now thankfully fully off.

The Neurologist, who is not an AME will just classify your fit after a thourough examination as "acute symptomatic" with the risk of reccurent like that of a normal person, since the trigger for that doesn't exist any longer (or is avoidable).

The AME/CAA will "translate" that according to CLASS 1 - AMC1 MED.B.065 (a) Epilepsy 1)... ( https://www.caa.co.uk/aeromedical-ex...e-material-gm/) , so to you applies:

"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 after neurological evaluation". This complies with ICAO Part III 10.2.36 "....Acute symptomatic seizures (e.g. related to hyponatraemia) do not portend chronic seizure potential and allow medical certification...Additionally, recurrence risk must be assessed; if greater than one per cent per year, medical certification is not appropriate."

Unlike in the ICAO-Doc, there are no probability values written in the Regulations of UK-CAA or EASA like the 1%-rule. This "rule" has just been mentioned in the ICAO to make clear, how the regulation about an acute symptomatic (single) seizure complies with the requirement of a 1% probability (or less) of recurrence of any sort of failure in a year, explained in Part I Chapter 3. And do not confuse this with "1% in 5 years".ICAO Part III 10.2.39 mentiones 4 years free of occurences and medical treatment, which has been adopted by the FAA, but this is about seizures, which don't classify as "acute symptomatic". EASAs only official time value about this is 10 years free of seizures and off treatment.

Thank you so much for explaining this Memphis Hubert, albeit I will have to read this a few times to understand it. I will respond with more detail in time but just wanted to say thanks for this information.

About this, if I am able to seek a second opinion from another neurologist, and am able to somehow reduce this 5-years and appeal to the CAA, could they effectively turn around and say please wait 10-years?

Just keep it simple and don't care about probabilities. The CAAs regulation is more or less based on the ICAO doc, so they will bring "probabiity of a normal person" and the 1%-rule in line. For you just the outcome is relevant - to get your medical back.
If the neurological examination didn't yield any signs of epilepsy - spikes, slowings, lesions etc, then your fit will be categorized as "acute symptomatic" and you should be fine.

Once again - the 4 years (not 5) refer to ICAO/FAA as a waiting period after a Single Unprovoked Seizure , with the UK CAA and EASA having that (officially) raised to 10 years. Once again check out the above linked FAA-Guide for Aviation Medical Examiners - SEIZURE.

In your case that doesn't apply, since you got an Acute Symptomatic Seizure, and it should be diagnosed like this by any Neurologist. This is dealt with in a different way, see my posts above.

Hi, thank you so much again for this, this is definitely starting to make sense a bit more. So what could/would my options be? At the time I didn’t know about this 1% thing but I did sort of know that a ‘provoked’ seizure cause is better than unprovoked. I just thought the 1% was just a statistic.

If I had the option to do so, and I do.. should I seek a second opinion? Or literally contact the CAA to take this further? As I’ve been doing everything through my AME who did say that overturning the CAA’s current decision could be difficult..

Theres a lot more to this in that I’ve had to spend out a lot of money on things over the past year, reduced pay, moving, uncertainty etc. it’s taken its toll for sure!

Just stick to the CAA-regulation and don't care about 1%. This has been an attempt to establish some sort of statistics, where there were no before. In your case "probability of recurrent like that of a normal person" has to be diagnosed.

To us being ruled by EASA the UK-CAA has always been described as pilot friendly, so wait for there outcome. I'm not familiar with the administrative regulations in UK, but probably you could appeal, couldn't you? If not, check this link https://www.caa.co.uk/media/terk0gi1...nt-final-2.pdf for a secondary review. Reading through this doc, it appears, that UK-regulations still are more or less equal to EASA, despite the Brexit.However the whole procedure appears to be much more "customer friendly".

May be someone else comments here, being more familiar with the UK.

As you say, that you spent a lot of money, had reduced pay and so on, you should consider yourself happy not being licensed with the worst EASA-CAA, which is the German "Luftfahrtbundesamt". This agency has been known for desastrous outcome of their aeromedical department, especially since the suicide induced crash of Germanwings 9525 in 2015, however beyond isolated cases no one really objected, this is owed to the Germans still being the most obedient folks worldwide, suffering a high degree of pathologial subordination. Now, as many pilots are waiting more and more months/years for the reissuance of their medical, having no income, they partially woke up, having launched an online petition to the German ministry of traffic and infrastucture. Reading in the comment section the whole dimension of this desaster becomes appearent.

I guess you're in a much better situation over there in the UK.