What are the guidelines for individuals with epilepsy on antiepileptic (AED) medication, such as carbamazepine (Tegretol), lamotrigine (Lamictal), or levetiracetam (Keppra), who wish to participate in scuba diving?

Guidelines for People on Epilepsy Medication and Scuba Diving

Scuba diving is not recommended for people with epilepsy, including those on antiepileptic medications, due to the potentially fatal consequences of having a seizure underwater. 1

Risk Assessment for Epilepsy Patients

The guidelines for individuals with epilepsy who wish to scuba dive are primarily based on the risk of seizure recurrence, which could be fatal if it occurs underwater. The current recommendations vary between medical organizations:

• Standard Guideline Approach: Most diving medicine authorities consider epilepsy to be either an absolute contraindication or require a significant seizure-free period 1, 2
• Seizure-Free Requirements:
  • United Kingdom Sport Diving Medical Committee recommends individuals must be seizure-free and off medication for at least 5 years 3
  • Some authorities permit diving after 3-5 years without seizures 2

Specific Considerations for Patients on AEDs

For individuals specifically on antiepileptic medications such as carbamazepine, lamotrigine, or levetiracetam:

• Medication Effects on Driving Performance: While chronic monotherapy with carbamazepine, valproate, lamotrigine, and levetiracetam does not significantly impair driving performance 1, scuba diving presents unique physiological challenges not present in driving
• Risk Never Eliminated: Even with long-term seizure control on medication, the risk of seizure recurrence is never completely eliminated 3
• Medication-Specific Concerns:
  • Initial administration of AEDs may affect performance and cognition 1
  • Some medications may cause drowsiness, dizziness, or cognitive effects that could compromise diving safety 4

Alternative Recommendations for Determined Individuals

Some researchers have proposed more lenient guidelines for highly motivated individuals with well-controlled epilepsy:

• Those who have been completely seizure-free on stable AED therapy for at least 4 years
• Not taking sedative antiepileptic drugs
• Able to fully understand and accept the risks
• Diving with a thoroughly informed buddy
• Limiting dives to shallow depths 3

However, these are not widely accepted recommendations and contradict the more conservative approach of most diving medicine authorities.

High-Risk Activities for Epilepsy Patients

Scuba diving is consistently listed among high-risk activities that are not recommended for people with epilepsy, along with:

• Free climbing
• Hang-gliding
• Activities involving heights without safety equipment 5

Important Caveats and Warnings

• An in-water seizure has an extremely high likelihood of being fatal 2
• Long-term follow-up studies show at least one-third of people with epilepsy will have a seizure recurrence, with risk remaining elevated for many years 2
• There have been documented near-fatal cases of individuals with epilepsy who attempted scuba diving 2
• The physiological stresses of diving (pressure changes, gas exposure, nitrogen narcosis, oxygen toxicity) may potentially lower seizure threshold 3

The medical consensus remains clear that scuba diving represents an unacceptable risk for individuals with epilepsy, even those with good seizure control on medication, due to the potentially fatal consequences of having a seizure underwater.