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Seizures Common at 30,000 Feet

Neurological problems cause a third of emergency landings

MONDAY, June 24, 2002 (HealthDayNews) -- The stock image of an in-flight medical emergency is a traveler clutching his chest, with an unscheduled landing needed for quick treatment of a heart attack.

However, a new study finds that neurological problems, such as epileptic seizures, are responsible for one in three medically-related emergency landings.

The finding adds fuel to a running debate about having drugs for epilepsy on planes.

The report, appearing in tomorrow's issue of Neurology, comes from the Mayo Clinic Scottsdale branch in Arizona, which advises about in-flight problems to Northwest Airlines, which flies 10 percent of all U.S. passengers.

A group led by Dr. Joseph Sirven, director of the epilepsy center at Scottsdale, analyzed more than 2,000 airborne medical incidents that resulted in 312 emergency landings between 1995 and 2000. Nearly a third of the problems arose from neurological symptoms such as severe dizziness and seizures, the researchers say, and they were responsible for 107, or 34 percent, of the emergency landings -- second only to heart problems.

The cost for these neurological-related "diversions" -- not taking into account the trouble it causes other passengers -- is about $9 million a year, the study says.

"We can now support our recommendation that major airlines carry anti-epileptic drugs in their emergency medical kits," Sirven says in a statement. "Given the high cost and inconvenience associated with emergency landings, we would also like to encourage more public health education, as well as flight crew training, to improve in-flight neurological care."

It's a laudable goal, says Alexandra Finacune, vice president for legal and government affairs of the Epilepsy Foundation of America, but she adds the foundation has a more immediate concern: getting persons with epilepsy onto airliners in the first place.

In a simple-minded way, airline discrimination against persons with epilepsy is understandable, Finacune says. An airline wants to avoid exactly the kind of emergency landing described in the Sirven paper, and so it may refuse to allow someone who acknowledges epilepsy on board a flight.

Airline personnel can find out when they see someone wearing a wrist band that warns of the possibility of seizures, or when the potential passenger gives notice of the condition to alert the flight crew. The reaction too often is panic rather than understanding, she says.

"We hear about it regularly, people with epilepsy being denied boarding," Finacune says. "Right now, many people are afraid to tell the airline because they are worried that they can't get on a plane."

It's an unwarranted reaction, she says, because a person who has epilepsy will be taking medication that makes a seizure improbable. However, seizures can occur in persons who have not been diagnosed with epilepsy, Finacune says. One of every 10 persons will have a seizure at one time or another -- and those are the ones that are likely to cause problems requiring an emergency landing.

The Epilepsy Foundation has not taken a stand on whether anti-epilepsy drugs should be included in airline emergency kits, she says, because those are not easy to administer. The most widely used medications have to be given intravenously, Finacune notes, "and so you would need a doctor available to know how to administer them."

"The more interesting issue is that they recognize the need for better public health education," she says of the Mayo report. What the foundation wants is better observance of the Air Carrier Access Act, which rules out such discrimination, but which often is ignored in practice, Finacune says. The act, passed in 1986, does allow exceptions if the pilot believes a person is likely to cause an emergency landing.

What To Do

If you have questions about epilepsy and air travel, you can get answers from the Epilepsy Foundation of America. Also, read this pamphlet from the Federal Aviation Administration about access for people with disabilities.

SOURCES: Alexandra Finacune, vice president, legal and government affairs, Epilepsy Foundation of America, Washington, D.C.; June 25, 2002, Neurology
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