PubMed · 15401164
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H A SMEDAL, A P WEBSTER. 1949. Safe parachute descent; an unsolved problem.. https://pubmed.ncbi.nlm.nih.gov/15401164/
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It can be seen that aspects of different environments can have adverse effects on normal, healthy nervous systems. Aerospace and underwater neurology consultants are often required to evaluate aviators, divers, or astronauts who have neurologic problem to determine whether they should be granted a waiver. In general, these considerations include course of the disorder (static, progressive, or paroxysmal), potential for sudden incapacitation that may compromise safety, predictability of course of the disorder, ability to monitor disease, and potential adverse effects of medications. A background in the toxic effects of an abnormal environment on the nervous system can be used to make better clinical judgements when considering effects of exposing someone with an abnormal nervous system to such environmental stressors.
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.