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experience a benign course with little or no deficit. Treatment with immuno-modulatory agents
(glatirimer acetate, beta-1a and beta-1b interferon) does not preclude certification. When recovery from
an exacerbation has occurred and stability under observation has been documented, medical certification
is appropriate. With minor occurrences, a three month period of observation may be sufficient, whereas
six to twelve months may be more appropriate when more significant disease is present.
Operational Considerations
Operational considerations are important in medical certification of individuals with neurological
disorders. Single pilot operations, with the prospect of immediate deployment may be disqualifying for
certain conditions such as migraine and multiple sclerosis, whereas airline pilot operations may be
compatible with certification. Multicrew operations will often confer an additional measure of risk
mitigation, allowing favourable aeromedical dispositions. The same is true for air traffic control duties,
where single controller positions can be avoided. Additionally, circumstances may allow assignment to
non-safety sensitive air traffic control duties during a period of observation that might lead to favourable
medical disposition. Thus operational considerations may allow some latitude in the medical certification
process.
ICAO Preliminary Unedited Version — October 2008 III-10-16
CONCLUSION
In the aeromedical disposition of licence holders with neurological disorders, the medical assessor must
use the time honoured tools of the history, the examination, review of records, and the laboratory
findings. Combining these elements with his or her experience and the evaluation of a neurologist, the
medical assessor can arrive at the appropriate aeromedical disposition.
RECOMMENDED READING
Headache
Raskin NH. Paroxysmal disorders: migraine and other headaches.
In: Rowland LP, ed. Merritt’s textbook of neurology, 9th ed.
Baltimore: Williams & Wilkins, 1995:838.
Transient Global Amnesia
Hodges JR. Transient amnesia, clinical and neuropsychological
aspects. London: WB Saunders, 1991.
Syncope
Olshanksy B. Syncope: overview and approach to management. In:
Grubb BP, Olshansky B, eds. Syncope: mechanisms and management.
New York: Futura Publishing, 1998:33.
Cerebrovascular Disease
Sacco RL, Adams R, Albers G, et al. Guidelines for prevention
of stroke in patients with ischemic stroke or transient ischemic
attack: a statement for health care professionals from the American
Heart Association/American Stroke Association Council on stroke.
Stroke 2006; 37:577–617.
Chobanian AV, Bakris GL, Black HR, et al. National high blood
pressure education program coordinating committee. The seventh
report of the Joint National Committee on Prevention, Detection,
Evaluation and Treatment of High Blood Pressure: the JNC-7
report. JAMA 2003; 289:2560–2572.
Musolino R, La Spina P, Granata A, et al. Ischemic stroke in young
people: a prospective and long-term follow up study. Cerebrovasc
Dis 2003;15(1–2):121–128.
Hardie K, Hankey GJ, Jamrozik K, et al. Ten-year risk of first
recurrent stroke and disability after the first-ever stroke in the
Perth Community Stroke Study. Stroke 2004; 35:731–735.
Verona JF, Bermejo F, Guerra JM, et al. Long-term prognosis
of ischemic stroke in young adults. Study of 272 cases. J Neurol
2004; 251(12):1507–1514.
Epilepsy
Aronson AE, Auger RG, et al. Chapter 15: Electroencephalography. AQ4
In: Mayo clinic examinations in neurology, 5th ed. Philadelphia: WB
ICAO Preliminary Unedited Version — October 2008 III-10-17
Saunders, 1981:287.
Hauser WA, Rich SS, Annegers JP, et al. Seizure recurrence after
a first unprovoked seizure: an extended follow up. Neurology
1990; 40:1163–1170.
Traumatic Brain Injury
Annegers JF, Hauser WA, Coan SP, et al. A population-based
study of seizures after traumatic brain injuries. N Engl J Med
1998; 338(1):20–24.
Intracranial Neoplasms
Shou SN, Kramer RS, Shapiro WR. Neurological and neurosurgical
conditions associated with aviation safety: intracranial
tumors—panel 2. Arch Neurol 1979;36:739.
General Readings
Aminoff MJ, ed. Neurology and general medicine, 2nd ed. New York:
Churchill Livingstone, 1995.
Rowland LP, ed. Merritt’s textbook of neurology, 9th ed. Baltimore:
Williams & Wilkins, 1995.
Wiebers D, DaleAJD, Kokmen E, et al. eds. Mayo clinic examinations in
neurology, 7th ed. St. Louis: Mosby, 1998.
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III-11-1
Chapter 11
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Manual of Civil Aviation Medicine 2(33)
