The use of EEG in aircrew selection

The value of the electroencephalograph (EEG) as a screening device in aviation medicine is questioned, because few subjects are disqualified on grounds of an EEG exam. At the Netherlands Aeromedical Institute, pilot applicants are rejected with a diagnosis of epilepsy or with severe EEG abnormalities (including epileptiform patterns where epilepsy is highly suspected). Although several studies have shown a low incidence of epileptiform EEG abnormalities in candidate pilots, subjects with an epileptiform EEG have a substantially increased risk of sudden incapacitation during their flying careers. In this review, we calculate the probability that a candidate with epileptiform EEG, but no history of epileptic seizures, will develop seizures during his flying career. This probability is about 25%, more than 12 times higher than for subjects with normal EEG and no history of epileptic seizures (2%). Subjects with epileptiform EEGs not only have increased risk of future epileptic seizures, but additionally it is recognized that epileptiform EEG discharges may be associated with episodic functional impairment, which can be a danger when a subject is flying. Taking this into account, one should consider rejecting all candidates with epileptiform EEGs in the future. This is at the expense of a small group of subjects with false-positive EEGs, but we believe that concern for public safety must override other considerations in these rare cases. To improve the understanding of the usefulness of the EEG in pilot screening procedures, an international classification and coding system should be developed, so that data from different countries can be compared.