Healthy Pilot #10: Neurological Disorders

While there are some rare instances when a history of seizures, paralysis or other neurological events wont be disqualifying, any presentation of a neurological disorder is usually met by an adverse FAA decision. Neurological disorders are item 18L on the Basic Med checklist.

While there are some rare instances when a history of seizures, paralysis or other neurological events won't be disqualifying, any presentation of a neurological disorder is usually met by an adverse FAA decision. Neurological disorders are item 18L on the Basic Med checklist.

The FAA's Guide for Aviation Medical Examiners is helpful if you think you might have suffered this kind of situation: The condition is defined as "a disturbance of consciousness without satisfactory medical explanation of the cause." The disposition requires an FAA decision, and unless certain criteria are met, that decision usually runs against the pilot.

We once again turn to AVweb's sister site, University Health News, for some answers. In its February, 2018 piece Seizures: Causes, Triggers, and Treatments, UHN explains, "a seizure is when the brain becomes over-stimulated, causing it to function abnormally (and therefore causing the body to do weird things). The brain is made up of neurons, specialized cells that create and transmit electrical impulses between each other to communicate. The transmission of these impulses is responsible for everything you can do, from walking, to digesting food to remembering what day it is. When a person has a seizure, this electrical activity gets out of control."

There are two main types of seizures. The type that most people are familiar with is a grand mal seizure, also known as convulsions. This type of seizure is usually characterized by the person's body going stiff and then rapidly jerking.

Focal seizures are limited to a smaller area of the brain, and thus affect only part of the body. One arm might jerk, or the person may uncontrollably chew and smack his or her lips.

"Absence seizures" are when the person seems to zone out and stare. Also, there are muscular disorders that may cause episodes and movements that look like a seizure but are not.

Most seizures last only a couple of minutes. If the seizure is prolonged, or if the person experiences several seizures one after the other, the brain can overheat and cause permanent damage.

Seizures can be caused by physiological states in the body, such as:

  • Low blood sugar
  • Fainting
  • Stressor ananxiety attack
  • Strong emotions
  • Hard exercise
  • Lack of sleep
  • Hormones

Seizures can also be triggered by things in the environment, like:

  • Flashing lights
  • Loud noises
  • Chemical smells

Some people experience sensations before or during a seizure. These sensations are called auras. An aura could be unexplained fear, not feeling well, or a smell or sound that no one else can sense. These auras can occur alone or may precede a grand mal seizure.

How are Seizures Treated?

Seizures are really more of a symptom than an actual disease, so when possible, doctors will treat the underlying cause of the seizures. For example, if the patient has a brain tumor, removal or reduction of the tumor will most likely resolve the seizures. Infections will be treated with appropriate antibiotics, and seizures caused by diabetic shock will be resolved once the person's blood sugar levels have been stabilized. Seizures caused by hormonal fluctuations can be treated with hormone therapy. If the cause of the seizures is psychological—stress, for example—anti-anxiety medications will be prescribed.

There are a variety of anti-seizure medications on the market, each with its own pluses and minuses. You'll need to work with your doctor to select the best medication for you, and expect that determining the optimal dose may take some adjustments.

Some medications have side effects that will go away as your body becomes used to the drug, while others may persist (if this happens, consult with your doctor to try a different medication). As with any medication, you want to get the best results with the least number of side effects. If necessary, multiple medications may be taken at once.

For anti-seizure medication to be effective, it is important to follow instructions carefully and take your medication at the same time every day. Also, discuss any other medications that you are on or might consider taking with your doctor to avoid any potential drug interactions.

Yes, there are instances where a history of seizures does not result in the loss of pilot privileges. Those instances include childhood "febrile" seizures occurring prior to age 5, with no recurrence and no resort to medication. Also, a history of so-called Rolandic seizures—defined as benign childhood epilepsy with no recurrence—may not interfere with your flying.

The language from the FAA circular on the subject reads in part: Infrequently the FAA has granted an authorization under the special issuance section of part 67 (14CFR 67.401) when a seizure disorder was present in childhood but the individual has been seizure-free for a number of years. Factors that would be considered in determining eligibility in such cases would be age at onset, nature and frequency of seizures, precipitating causes, and duration of stability without medication. Follow-up evaluations are usually necessary to confirm continued stability of an individual's condition if an Authorization is granted under the special issuance section of part 67 (14 CFR 67.401).

The FAA Airman Seizure Questionnaire is densely written, but it's helpful in parsing out exceptions and qualifications, should you and your physician decide to challenge the FAA.

For instance: "Have you ever had a grand mal seizure or a big seizure where you lost consciousness or your whole body shook and stiffened?" Or "do you ever have a warning before your big seizure?" Or "have you ever had a small ‘spell'" that lasted for more than two minutes?

The questionnaire also asks you to identify any unexplained feelings, smells, tastes, sights or sounds, possibly indicative of a neurological event.

As you can see, seizures are the kind of thing that the FAA takes extremely seriously when granting access to the nation's airspace.