Electroencephalogram epileptiform abnormalities in candidates for aircrew training

Area of Science:

• Neurology
• Aerospace Medicine
• Medical Screening

Background:

• The Royal Air Force has utilized electroencephalography (EEG) for 30 years in the medical screening of aircrew candidates.
• This practice aims to identify individuals with potential neurological conditions that could affect flight safety.
• Previous studies have explored the predictive value of EEG abnormalities in asymptomatic populations.

Purpose of the Study:

• To evaluate the incidence of epileptiform discharges in young, healthy male candidates for aircrew training.
• To determine the long-term risk of developing epilepsy in individuals identified with specific EEG abnormalities during screening.
• To assess the utility of EEG as a screening tool for epilepsy risk in aviation personnel.

Main Methods:

• Analysis of EEG data from 13,658 male candidates (aged 17-25) with no significant prior illness.
• Identification of unequivocal epileptiform discharges, with a focus on those occurring during photic stimulation.
• Longitudinal follow-up of a subset of 43 individuals with EEG abnormalities over 5-29 years to monitor epilepsy development.

Main Results:

• Sixty-nine candidates (0.5%) exhibited unequivocal epileptiform discharges, with 58% of these occurring solely with photic stimulation.
• Individuals with EEG discharges of uncertain significance were excluded from the primary analysis.
• In the follow-up group, only one individual developed unequivocal epilepsy, suggesting a low conversion rate.

Conclusions:

• Healthy individuals with specific EEG abnormalities identified during aircrew screening have a low, estimated 2-3% risk of developing epilepsy.
• EEG appears to be a valuable, albeit not perfect, tool for identifying individuals at a potentially elevated risk for epilepsy within this specific demographic.
• These findings support the continued use of EEG in the medical screening of aviation candidates to ensure safety.