From the Guidelines
Individuals with a history of seizures are generally advised not to scuba dive due to the significant safety risks involved, and most diving organizations recommend a waiting period of at least 3-5 years without medication before considering scuba diving, as stated in general guidelines 1. The primary concern is that having a seizure underwater could lead to drowning, as the diver might lose consciousness, spit out their regulator, or be unable to control their buoyancy. Some aspects of diving, such as hyperventilation, oxygen toxicity at depth, and nitrogen narcosis, can potentially lower the seizure threshold, increasing the risk of a seizure occurring during a dive. Additionally, certain anti-seizure medications may cause side effects like drowsiness or impaired coordination, which could further compromise diving safety. It is essential for anyone with a history of seizures who wishes to dive to consult with both a neurologist and a physician trained in dive medicine for personalized advice based on their specific medical history, as the risk of seizures and the safety of diving can vary greatly from person to person 1. In general, guidelines suggest that individuals with seizures should avoid activities that could put them or others at risk, such as driving or operating heavy machinery, and scuba diving is considered a high-risk activity in this context. Therefore, it is crucial to prioritize the safety of the individual and others by following the recommended guidelines and consulting with medical professionals before engaging in scuba diving with a history of seizures.
From the Research
Guidelines for Seizures and Scuba Diving
- The Sport Diving Medical Committee in the United Kingdom advises that individuals with epilepsy must be seizure-free and off medication for at least 5 years to dive 2.
- However, a study suggests that people with epilepsy who have been entirely seizure-free on stable antiepileptic drug therapy for at least 4 years, and are not taking sedative antiepileptic drugs, may be able to consider diving to shallow depths, provided they and their diving buddy understand the risks 2.
- Another study highlights the importance of education for doctors, dive professionals, and divers about the risks associated with epilepsy and diving, and presents cases where individuals with a history of epilepsy almost fell through the cracks of health risk assessment 3.
- The risk of seizures recurring decreases with increasing time in remission, but the risk is never completely abolished 2, 3.
Risk Assessment and Management
- Long-term follow-up of people with epilepsy shows that at least one-third will have a recurrence, and the risk remains elevated for many years 3.
- An in-water seizure is highly likely to be fatal, emphasizing the need for careful risk assessment and management 3.
- Diving to shallow depths may be considered for individuals with epilepsy who meet certain criteria, but both the individual and their diving buddy must fully understand the risks 2.
Antiepileptic Drug Therapy
- Studies have compared the efficacy of different antiepileptic drugs for patients with generalized epileptic seizures, with some suggesting that lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures 4, 5.
- However, the choice of antiepileptic drug therapy should be individualized, taking into account the specific type of seizures, the risk of recurrence, and the potential side effects of the medication 4, 5, 6.