Epilepsy and recreational scuba diving: an absolute contraindication or can there be exceptions? A call for discussion.
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.
Almeida
Maria do Rosario G
Mdo R
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Bell
Gail S
GS
Sander
Josemir W
JW
D026683:Advisory Committees; D000927:Anticonvulsants / Q000009:adverse effects; D002423:Cause of Death; D003617:Dangerous Behavior; D003665:Decompression Sickness / Q000209:etiology; D004242:Diving / Q000009:adverse effects* / Q000502:physiology / Q000592:standards; D004827:Epilepsy / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007222:Inert Gas Narcosis / Q000209:etiology; D010100:Oxygen / Q000506:poisoning; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom
D000927:Anticonvulsants; D010100:Oxygen