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Is scuba diving safe?

A leading epilepsy expert is calling for a review of the regulations relating to scuba diving.

This increasingly popular sport is governed in the UK by the sport diving medical committee who advise that to dive someone with epilepsy must be seizurefree and off medication for at least five years. This view is shared by the Professional Association of Diving Instructors and the National Association of Underwater Instructors.

But NSE’s Professor Ley Sander is calling for a review which would allow people who have been seizure-free and on stable medication for at least four years to be considered to be allowed to dive to shallow depths.

Professor Sander said: “The reasons for the current restrictions are mainly theoretical. Exercise is often beneficial for people with epilepsy. My advice would be that people wanting to take part in this pastime, who have been seizure-free for four years, should build up their exercise tolerance and if they remain seizure-free should be allowed to take part.”

The research recently published in the journal Epilepsia looked at six key areas:

• The physiological risks for anyone scuba diving
• Whether those risks were greater for someone with a history of seizures
• Whether anti-epileptic drugs themselves posed a risk for someone scuba diving
• Whether seizures were likely to be induced by recreational scuba diving in people with epilepsy controlled by medication
• Whether recreational diving by a person with controlled epilepsy was likely to endanger the life of others
• The benefits of diving to people with epilepsy.

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Commented Professor Sander: “In the first instance we looked at the inherent risks of scuba diving – decompression sickness, oxygen toxicity and nitrogen narcosis, – and whether those risks were increased in someone with controlled epilepsy. It was felt that someone with uncontrolled epilepsy might experience decompression illness if they had a seizure under water and a rapid ascent was necessary.

“As far as oxygen toxicity is concerned, very little information is available – just two reports in connection with seizures, for which there could have been another explanation. There is no reason to suspect that people with a history of seizures would be more likely to suffer from nitrogen narcosis.”

The risks were then looked at again in relation to someone taking anti-epileptic drugs (AED).

Professor Sander said: “Again the risks did not seem to be increased. The only note of caution was in relation to someone who knew that their AED had a sedative effect which might impair their performance and reaction time.

“One thing that does need consideration is the health and safety of the diving buddy. If a diver had a seizure at depth, the buddy would need to reach the surface quickly, putting himself at risk of decompression illness.”

When considering the likelihood of seizures being induced by scuba diving, Professor Sander said that regular exercise was proven to be positively beneficial to people with the condition.

He continued: “I would suggest that potential divers should be given the best individualised advice available and should be warned of the risks and dangers so they can make an informed decision.

“It is a controversial issue and more research is needed to evaluate the risks. The practitioner can only give the patient the best currently available information and then the decision as to whether to dive has to be the result of a consensus between the person with controlled seizures, the diving buddy, the insurer and the family.”

July 2007