As a verb it denotes attaching or installing an item, compatibility, joining together, or being the right size or shape. As a noun, it means seizure, the frightening and dramatic loss of bodily control people associate with epilepsy. Except it doesn’t; many seizures are not due to epilepsy, and their depiction in the media is often woefully inaccurate. And why is this relevant to my readers? Simple. Not all seizures are due to epilepsy, which affects up to 10% of people worldwide during their lifetime, so you, or someone you know or love, may have the symptoms or signs of a serious underlying disease, and knowing about this could save a life.
Epilepsy is derived from Greek epilambanein, meaning to seize or attack because the person involved may be overwhelmed when it happens. Seizures occur when there are brief episodes of abnormal electrical activity generalized across the entire brain or very focal. If the latter, the symptoms experienced are predictable based on which part of the brain is firing randomly. They can result from many causes, including bacterial, viral, or other infectious diseases causing swelling of the brain or its surrounding membranes, the meninges (hence meningitis) and high fevers from other infections, especially in children.
Trauma can also induce subsequent seizures as can benign or malignant brain tumors (of which secondary tumors from lung, breast, colon, kidney, melanoma, and prostate cancer are most common) stroke, alcohol or drug use or withdrawal, diabetes and other hormonal or metabolic problems, disturbed blood electrolytes, and kidney or liver failure. And then there is epilepsy, a chronic disorder that leads to seizures and other symptoms, and many now call the disease “seizure disorder.”
The “classic” depiction of a seizure involves falling to the ground and twitching uncontrollably, but this does not begin to characterize what might happen. There are four phases, but not every person has all the stages, and the duration of each may vary enormously, which, when combined with the associated stigma, impedes early and accurate diagnosis.
Seizures may commence with no obvious triggers, but some people are sensitive to rapidly flashing or strobe lights, certain foods, or being tired or stressed. Aviation linguistic tools like acronyms and acrostics are aide-memoires pilots use daily to stay alive; think ACAS, APU, GUMPS, or IM SAFE. Here is an alliteration tool that might also save a life: Short, Sudden, Strange, Similar Spells. A seizure might be something like hearing a conversation but the words don’t make sense, or a particularly intense daydream. If these “S’s” ring a bell, ask those you spend time with if they notice anything about you during such an episode and see your doctor.
If a physician suspects a seizure disorder, they will take a full and detailed medical history, complete a thorough physical examination, and order relevant tests including bloods, chest X-ray and various brain scans, and electrical mapping with EEG. If no initiating cause is identified, once a person has suffered two or more seizures, a diagnosis of epilepsy or chronic seizure disorder is made.
Treatment is directed at a primary cause if identified and then anti-epileptic drugs (AEDs), of which there are around 30 available, to control the seizures. A ketogenic, high-fat diet may reduce the episodes, although of course other health issues need to be taken into consideration. A novel technique of treating this condition involves placing an electrode near the vagus nerve in the neck attached to a pacemaker device inserted under the skin of the chest. This neuromodulation approach uses electricity to change brain behavior, a technology now widely deployed for many conditions. In some severe cases, with careful mapping to identify the brain region responsible for seizures, a neurosurgeon can remove or destroy that area. Although epilepsy may be for life, it might diminish with time, and while one can live a full existence, certain pastimes like swimming alone are unwise, and there are obvious restrictions regarding driving or flying.
Once diagnosed, adherence to treatment is critical, and one must take responsibility for recognizing warning signs and symptoms that could precede a seizure, such as unusual auras or changes in behavior. Are there implications for your flying? Absolutely, but ignoring the symptoms described could end more than your flying.
If you suspect you may have suffered a seizure, self-ground until everything is properly investigated and transparently disclose the condition with your AME. This disclosure ensures that any necessary precautions or recommendations can be made before potentially taking to the skies because a seizure while airborne puts you—and others—at risk. Incidentally, as I have described previously, whenever I took someone aloft, I always requested their medical history, specifically asking about diabetes, epilepsy, asthma, and cardiac problems. Imagine having a burly chap suffer a seizure in the right seat of a small GA aircraft. That could jeopardize both our lives!
Generally speaking, the FAA requires that a pilot with epilepsy remain seizure-free for a minimum of 10 years and off seizure medications for at least 3 years before they are eligible for a special issuance medical certificate. This is a critical gap in the safety equation; the absence of seizures over this extended period reduces the likelihood of an event occurring during flight, making the pilot eligible for certification if all criteria are met, including documented medical evidence from a neurologist confirming the condition is well-controlled.
As with all medical challenges, outcomes are better if your general health is better. So aim to be fighting fit, as fit as a fiddle, eat food that is fit for human consumption, and don’t have a hissy fit if ATC puts you in a hold! I am sure you will recall a deceased, disgraced former NFL player, and the line “If the glove don’t fit, you must acquit.” Just as not having a fit was ideal for the accused in the famous case, it is ideal for you also. But if you do have one, find a doctor who is fit for purpose and can fit you into his or her schedule ASAP!
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