The electroencephalogram as a screening tool in pilot applicants

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.