Scuba diving and epilepsy

Inspired by a patient

Almeida Mdo R, Bell GS, Sander JW. Epilepsy and recreational scuba diving: an absolute contraindication or can there be exceptions? A call for discussion. Epilepsia. 2007 May;48(5):851-8. doi: 10.1111/j.1528-1167.2007.01045.x. PMID: 17508997.

Abstract

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.

Smart D, Lippmann J. Epilepsy, scuba diving and risk assessment. Near misses and the need for ongoing vigilance. Diving Hyperb Med. 2013 Mar;43(1):37-41. PMID: 23508661.

Abstract

There is ongoing debate about the safety of scuba diving for individuals with a history of epilepsy. An in-water seizure is highly likely to be fatal. Recommendations for fitness to dive vary with some regarding epilepsy as an absolute contraindication to diving (South Pacific Underwater Medicine Society) and others permitting diving under strict criteria (United Kingdom Sport Diving Medical Committee) with diving to be postponed for a period of three to five years without seizures. Long-term follow up of people with epilepsy shows that at least one-third will have a recurrence and that the risk remains elevated for many years. We present three cases where individuals with a history of epilepsy (or likely epilepsy) almost fell through the cracks of health risk assessment, two with near-fatal consequences. These cases inform the on-going debate about fitness to dive for those with current or past epilepsy, and highlight the importance of education for doctors, dive professionals and divers about the risks associated with epilepsy and diving.

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Google AI

Scuba diving with epilepsy is generally not recommended due to the high risk of a fatal seizure underwater. While some diving authorities may allow it after a period of five years with no seizures and after stopping medication, this is only under strict conditions and involves a significant risk that must be accepted by the diver and their buddy. A seizure underwater would likely cause the diver to lose their regulator and drown.

Why scuba diving with epilepsy is dangerous

Seizures underwater are often fatal: A seizure underwater can cause the diver to lose their regulator, leading to drowning.

Triggers in the diving environment: Diving can increase the risk of a seizure due to potential triggers like fatigue, stress, anxiety, sensory deprivation, and nitrogen narcosis.

Medication side effects: Anti-epileptic medications can have sedative effects and may exacerbate nitrogen narcosis or cause it to occur at shallower depths.

Strict conditions for diving

Long seizure-free period: Some authorities may consider allowing a person to dive if they have been seizure-free for at least five years, and are also off all medication.

Medical clearance: It is crucial to consult with a diving doctor and a neurologist to discuss the risks and potential for medical clearance.

Understanding risks: The diver and their buddy must be fully aware of the increased risks involved.

Alternatives to scuba diving

Many other activities are safe and enjoyable for people with epilepsy, as long as precautions are taken and reasonable safety equipment is used.

Examples include biking, contact and non-contact sports, and running.