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Traveling with Epilepsy: Does air travel altitude lower seizure threshold?

posted in: Travel | 8

Over 20 years ago, I told my neurologist that before menstruation, my number of seizures increased. I had never been told (or read) my monthly cycle could be a trigger, but my gut feeling said it was. My doctor assured me that menstruation was not a trigger and the increase in my seizures was mostly likely stress related. She stuck to the facts, as doctors do. 20 years later, The Epilepsy Foundation released that 50% of female patients of childbearing age, are likely to have an increase in seizures related to the hormonal changes that occur with menstruation; a physiological change. My story is not to discredit my doctor’s knowledge, but to show doctors are limited to what is scientifically proven at that given time. Our knowledge of epilepsy is constantly evolving.

Is there a link?

In December, at the American Epilepsy Society conference sponsored by Sunovion and The Epilepsy Foundation, I met people that said after air travel they had an increase in seizures and believed the altitude was the cause. When speaking to their doctors, they had also been told it was most likely stress related. Even with that explanation, most felt there could be something else to trigger the increase. While there is no evidence that the likelihood of seizures increases at higher altitude, I believe it isn’t far-fetched to deduct a change in altitude could lower seizure threshold. Here’s what I learned while researching.

The WHO reports aircraft cabins are pressurized at lower air pressure than sea level. The typical cruising altitude ranges 36,000 – 40,000 feet; air pressure in the cabin is equivalent to the outside air pressure at 1,800 – 2,400 feet. This low air pressure decreases the oxygen level in your blood, a physiological change. Decreased oxygen in blood can lead to hypoxia, the lack of oxygen in your tissue, organs, and brain. Severe hypoxia is a known flight risk and has also been linked to triggering seizures. Low oxygen levels won’t harm the average flyer, but what about those predisposed to seizures? I wonder if it’s possible that the physiological changes that occur with lower air pressure can increase seizure risk. It’s only in the past 10 years that we learned people with cardiovascular problems have increased risks with air travel. Imagine what more will discover 10 years from now!

Sharing experiences

Hearing stories of epilepsy patients consistently having seizures after air travel has helped me appreciate how lucky I am. I’m so thankful that overall I am a healthy person and that epilepsy doesn’t hinder my travels. Unfortunately, for many epilepsy patients this does not ring true. This also reminds me how far away we are from truly understanding epilepsy. As mentioned before, our knowledge of epilepsy is constantly evolving. The more we question, the more likely researchers will want to provide an answer.

Your Turn

Has flying impacted your seizures? Please tell us your stories and your seizure triggers.

Follow Maureen Knorr:
I’m Maureen, and I have the dreaded epilepsy. You’re probably reading this because either you have epilepsy, or you love someone that has epilepsy. Whatever sparked your curiosity, I am happy to be sharing my experiences with you. From having seizures in foreign countries to begging pharmacists that don’t speak English for medication, I can definitely say that it's been an interesting journey. After years of practice, I have learned to live everyday without letting epilepsy bring me down (not an easy feat!), and have confidently concluded that it has given me a deeper appreciation of life. Hopefully reading about my ups and downs, and my everyday and not so everyday adventures will inspire you too! Welcome to my life of living well with epilepsy!

8 Responses

  1. Lauren Smith
    |

    Hi Maureen,

    I’m an Australian and had a Grand Mal seizure 2 days after flying home from the UK. It occurred while I was jogging and was really scary. I have had 2 before – both due to lack of sleep – but the last one was 12 years ago. I hadn’t had a seizure after a long haul flight before. It was all the more scary as I thought I was finished with Epilepsy.
    I have just started a big new job, moved in with my partner- both exciting things, but these things are coupled with new medication and drowsiness, anxiety and anxiety about anxiety – if you know what Au mean!
    Have you heard of jet lag causing seizures?
    Do you know if Keppra really dies cause drowsiness?
    I am taking the occasional Diazapam to help me sleep and I think this is exacerbating the drowsiness.
    Any comments from those who understand would be helpful.
    I am not a mother but had never thought of the implications of being a new mum and being fearful of dropping your child if you gave a seizure. That must have been tough.
    Thanks for your story.
    Lauren

  2. Maureen
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    Hey Lauren,

    I’m sorry to hear about your seizure. Especially since you thought you were done with epilepsy! I believe jet lag could trigger a seizure as it is related to sleep deprivation. It also seems that you have a lot of changes in your life at the moment, so that could certainly contribute to having a seizure as well.

    Clinical studies have shown that drowsiness is a common side effect of Keppra and Diazepam. I was very drowsy when I first started Keppra but after a few months that side effect faded. Diazepam always makes me drowsy so I only take it if I feel a seizure coming on. Let your doctor know you are concerned with the side effects and suspect the Diazepam is a major contributor. She/He will be able to make some changes to help that.

    Totally get the anxiety about anxiety! It’s the worst!

    Thanks,

    Maureen

  3. Diane
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    My son has had epilepsy since he was a baby and is now 50. A year ago after getting off a flight from Virginia to Michigan he haf a grand mal seizure in the terminal. He had flown many times before and never had a problem. He hit his head on th cement floor and suffered a brain bleed. He had another seizure after being admitted to the hospital that same day. A month later he had another one. Took 3 months for his brain bleed to stop. His seizures were well controlled before this. He actually had gone 14 yrs with no seizures at one point. Because of the brain injury his memory has been affected. He has no sense of smell, taste and has constant ringing in one ear as well as hearing loss. Yes, we firmly believe there is a connection between the flying and the seizures and he will never fly again. Although it had never happened before just not worth the risk.

  4. Maureen Knorr
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    Hi Diane,
    I am so sorry your son had that experince. I can’t imagine how hard that has been on you and him. And thank you so much for sharing your story. The more patients and caregivers share, the more attention and research we will get. If we keep sharing our stories, I believe one day we will know the risks of flying with epilepsy.
    Again, thank you for sharing.
    Best,
    Maureen

  5. Isabel Poncia
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    Hello

    I used to have Benign Rolandic Epilepsy when I was younger but have been meds free for 15 years now and seizure free. However I will be going to la paz in Bolivia in a week and just wondered if there will be a chance I could still have a seizure becuase of altitude with having a history of this type of epilepsy? Also if I have been siezure free for this long am I still considered to even have epilepsy or have I grown out of it?

    • Jessica Keenan Smith
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      Isabel,
      I would recommend that you talk to your doctor. He/She would be the best person to ask.

      Thanks for you note.
      Jessica

  6. Martin
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    I had a nocturnal seizure about 10 days after a trip to Australia for less than 2 days. I spent more time travelling then I did in Australia! I had no history of epilepsy. A CT scan done after I got to the ED was normal, but an MRI a few days later showed a small subdural hematoma. Subsequent scans showed that it cleared up within a month and a cerebral angio study was normal. I had 2 further nocturnal seizures and am now on lamotrigine. I have had a lot of stress in the last few years and suffer from parasomnia so I wonder whether all of these factors and the flights caused my epilepsy. It has been life changing for me and my family but we have supported each other and keep going.

    • Jessica Keenan Smith
      |

      Martin,
      I recommend you talk to your doctor. If you are not already seeing one, you may want to seek out a neurologist that specializes in epilepsy.
      Jessica