Scuba Diving and Seizure Risk in Epilepsy
Individuals with epilepsy or a history of seizure disorders should not engage in scuba diving due to the significant risk of in-water seizures, which are highly likely to be fatal. 1
Physiological Risks of Diving for People with Seizure Disorders
Scuba diving creates several physiological conditions that can lower seizure threshold and increase risks:
- Cerebral hypoxia: Prolonged breath-holding can decrease oxygen levels in the brain, a known seizure trigger 1
- Hyperventilation effects: Pre-dive hyperventilation can lower CO2 levels, potentially triggering seizures in susceptible individuals 1
- Mammalian dive reflex: Water immersion causes rapid blood pressure and heart rate fluctuations that may lower seizure threshold 1
- Decompression illness: Individuals with seizure disorders have increased risk of neurological decompression illness 1
- Oxygen toxicity: Elevated partial pressures of oxygen at depth can trigger central nervous system toxicity and seizures 2
Medical Guidelines and Recommendations
The British Thoracic Society and other medical organizations classify scuba diving as high-risk and generally contraindicated for people with epilepsy due to:
- Immediate drowning risk if a seizure occurs underwater
- Increased risk of decompression illness
- Potential complications from nitrogen narcosis
- Oxygen toxicity risks 1, 3
Most diving medical committees require individuals with a history of epilepsy to be:
- Seizure-free for 3-5 years
- Off all anti-epileptic medications
- Cleared by a physician with expertise in diving medicine 4, 5
Case Evidence and Outcomes
Multiple case reports document near-fatal consequences when individuals with epilepsy history attempt scuba diving:
- Studies show at least one-third of people with epilepsy will have a seizure recurrence, with risk remaining elevated for many years 5
- Several documented cases show individuals with epilepsy "falling through the cracks" of health risk assessment with near-fatal consequences 5
- An in-water seizure has an extremely high mortality rate due to the inability to maintain an airway 6
Alternative Water Activities
For individuals with epilepsy who enjoy water activities, safer alternatives with appropriate supervision include:
- Swimming in shallow water with direct supervision
- Snorkeling in shallow areas with a buddy system
- Surface water sports with proper flotation devices 1
Important Caveats and Considerations
- Even with controlled epilepsy, the risk of seizure recurrence is never completely eliminated
- The consequences of a seizure underwater are far more severe than on land
- Proper medical screening before certification is essential but sometimes inadequate
- Dive professionals and medical providers should be educated about these specific risks 5, 6
The medical evidence strongly supports avoiding scuba diving for those with epilepsy or seizure history, as the potential fatal consequences far outweigh any recreational benefits.