PubMed · 14001424
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R G WITWER, B G McDADE, C C COLE. 1963. Hearing conservation program evaluation.. https://pubmed.ncbi.nlm.nih.gov/14001424/
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The electroencephalogram (EEG) is used to screen pilot candidates for professional licensure irrespective of medical history in many European countries; applicants with paroxysmal abnormalities are excluded. The aim is to reduce the risk of later seizures in flight, which may cause accident or death, but there is no clear evidence that EEG screening can lead to any significant risk reduction. This is partly due to the low predictive value of the EEG, the low risk of seizure in healthy young adults, and the low risk of commercial aircraft accidents. Later-onset seizures, unrelated to the results of earlier screening, cannot be predicted or prevented by screening. Some benefit cannot be excluded, but may be difficult to demonstrate in prospective studies. Specialized screening of targeted populations, such as for photosensitivity in helicopter pilot candidates, may be justifiable; prospective studies with standardized recording and interpretation protocols are needed to assess this.
Current diagnostic electroencephalogram (EEG) investigations in aircrew selection and certification lack both standardization and reference to universally applicable criteria for their effective use. Extrapolation from clinical EEG studies may not be appropriate. Recent studies on serial EEGs in aircrew are lacking, whereas follow-up of individuals who failed certification is nonexistent. Population-based EEG studies in healthy subjects are generally underpowered to establish the significance of pathological EEG findings. Advanced digital video/EEG recording, in combination with standardization of data exchange formats and automated detection of pathological grapho-elements, is cost effective when carried out for extended periods, e.g., during flight simulator sessions. Extensive databases of serial video/EEG records in aircrew may thus be easily obtained and validated over time. Prognostic inferences on the significance of pathological EEG discharges may subsequently be derived from these databases.
Disqualifying criteria for aircrew in Europe (JAR-FCL 3) are, besides a diagnosis of epilepsy after the age of 5 and a history of episode(s) of disturbance of consciousness, epileptiform paroxysmal electroencephalographic abnormalities and focal slow waves. Intermittent photic stimulation (IPS) provokes in about 0.5% of healthy subjects (range 0-2%) a photoparoxysmal response and is most often the only abnormality (70-90%). The literature is scarce and shows great diversity in methodology. Standardized IPS with simultaneous video will not only allow collection of sufficient data for proper epidemiological studies, but can also reveal clinical and often unnoticed or misinterpreted signs and symptoms like myoclonia, loss of consciousness, and occipital seizures with visual auras. The pilot (sleep deprivation, strong sunlight) and the traffic controller (stress, monitors) are more prone to visually induced seizures. Furthermore, the increasing exposure to potentially seizure-triggering visual stimuli might have its impact in a more indirect or cumulative way.