Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, which involve abnormal electrical activity in the brain. The core question of whether a person with epilepsy can scuba dive is not a simple yes or no, but rather a conditional possibility that hinges on meeting extremely strict medical criteria. While active epilepsy is an absolute contraindication for diving due to the life-threatening risks, individuals with a history of the condition may be cleared to dive after a lengthy seizure-free period and thorough medical evaluation.
Medical Clearance and Eligibility Requirements
The decision to permit a person with a history of epilepsy to dive is made conditionally, based on guidelines from organizations like the Divers Alert Network (DAN) and the Undersea and Hyperbaric Medical Society (UHMS). Most major diving medical committees require a significant period of time without any seizure activity before considering clearance. This waiting period is typically five years seizure-free and completely off all anti-epileptic medication (AEDs) before a diver is considered eligible to apply for medical clearance.
This conservative five-year standard is based on statistical evidence showing that the risk of seizure recurrence decreases significantly over time. Some authorities may consider a shorter period of three years if the seizures occurred exclusively during sleep, but this is often handled on a case-by-case basis through a specialized medical review process. The person must secure a sign-off from a physician, preferably one specializing in neurology or dive medicine, who understands the unique physiological challenges of the underwater environment.
Compliance with any past or present anti-epileptic drug regimen must be carefully reviewed. Many AEDs can have sedative effects that may exacerbate nitrogen narcosis at depth. Remaining on medication, even with good seizure control, generally makes a person unfit to dive. If a medication change or missed dose were to occur, it could lower the seizure threshold, increasing the risk of a life-threatening event underwater.
The Unique Risks of Seizures During a Dive
When a seizure occurs while submerged, the consequences are severe and often fatal, justifying the stringent medical restrictions. The immediate danger is the loss of the regulator from the diver’s mouth, which leads to immediate aspiration of water and drowning. An unconscious or convulsing diver cannot maintain the airway and is vulnerable to inhaling large quantities of water.
A sudden, uncontrolled ascent is another grave risk, triggered by convulsive movements or a loss of consciousness and buoyancy control. Ascending too quickly causes the gases dissolved in the body’s tissues to expand too rapidly, increasing the probability of decompression sickness (DCS), commonly known as “the bends.” The sudden pressure change can also cause pulmonary barotrauma, where expanding air damages lung tissue, leading to an air embolism.
The diving environment can lower the seizure threshold in susceptible individuals due to factors like stress, fatigue, or the elevated partial pressure of oxygen at depth, which can induce oxygen toxicity seizures. Furthermore, a seizing diver places their dive buddy at significant risk during a difficult underwater rescue attempt.
Safety Measures for Divers with Epilepsy
If a person successfully navigates the strict medical clearance process and is deemed fit to dive, certain safety measures must be consistently followed. The diver must be paired with a highly trained and fully informed dive buddy who is aware of their medical history and the specific emergency action plan. This dedicated buddy must know how to safely manage a seizing or unconscious diver underwater.
To mitigate risk, the diver must strictly adhere to conservative dive profiles, limiting themselves to shallower depths and shorter bottom times. They should avoid decompression diving altogether, which requires extended time at depth, as this increases exposure to nitrogen and oxygen. This approach reduces the overall physiological stress of the dive.
Proactive avoidance of environmental triggers is paramount, including ensuring adequate rest, avoiding alcohol, and managing psychological stress before diving. Divers should practice controlled breathing and avoid hyperventilation, which can act as a seizure trigger. Following these protocols represents the necessary practical application of safety for those who meet the rare criteria for diving.