For individuals with a history of seizures or epilepsy, obtaining an FAA medical certificate can be challenging. The FAA has strict guidelines to ensure the safety of both the pilot and the public. This article explores the FAA’s medical certification process for individuals with a history of seizures, including the requirements, evaluations, and potential pathways to certification.

FAA’s Approach to Seizures and Epilepsy

The Federal Aviation Administration (FAA) categorizes seizure conditions based on their cause, frequency, and whether they have fully resolved. The goal is to determine if an applicant is at risk of recurrent seizures, which could impair their ability to operate an aircraft safely. The FAA’s medical clearance process is particularly stringent for conditions involving the central nervous system, such as epilepsy.

Categories of Seizures and Certification Requirements

The FAA classifies seizure cases into different categories, each with specific evaluation and certification guidelines.

1. Simple Febrile Seizures

A simple febrile seizure occurs in early childhood (age 5 or younger) and is associated with fever but no underlying neurological condition. If an airman has a history of a single febrile seizure that has fully resolved without recurrence, they may be issued a medical certificate without additional testing. The Aviation Medical Examiner (AME) will note this history in the medical examination report.

However, if there is any uncertainty regarding the diagnosis or if multiple seizures occurred, the applicant must undergo a detailed neurological evaluation before the FAA considers certification.

2. Single Seizure Provoked by a Known Cause

A single seizure with an identifiable, non-recurring cause—such as electrolyte imbalance, medication reaction, or convulsive syncope—may still allow for certification under certain conditions. The applicant must:

• Complete a one-year recovery period free of seizures.
• Undergo a neurological evaluation within 90 days of the medical examination.
• Provide a brain MRI to rule out underlying pathology.
• Complete a sleep-deprived EEG to assess brain activity.
• Submit the FAA Airman Seizure Questionnaire.

If all test results are normal and the treating neurologist determines the seizure was truly an isolated event, the FAA may consider granting a Special Issuance medical certificate.

3. Single Unprovoked Seizure

If an applicant has experienced a single seizure with no identifiable cause, the FAA requires a four-year seizure-free period before they can be considered for medical certification. The last two years of this period must be completely medication-free. The required evaluations are the same as those for a provoked seizure, including:

• A neurological examination
• A brain MRI
• A sleep-deprived EEG
• The FAA Airman Seizure Questionnaire

If no underlying epilepsy or recurrent seizure disorder is found, the FAA may grant certification on a case-by-case basis.

4. Epilepsy Diagnosis

For individuals diagnosed with epilepsy, certification is significantly more difficult. The FAA requires a ten-year seizure-free period with the final three years being medication-free. To be considered for certification, the applicant must submit:

• A current neurological evaluation (preferably by an epileptologist)
• A brain MRI
• A comprehensive EEG study, including a 24-hour EEG, sleep deprivation, and provocation testing
• The FAA Airman Seizure Questionnaire

If an applicant meets all the FAA’s stringent requirements and remains seizure-free, they may be granted a Special Issuance medical certificate. However, cases are reviewed carefully, and additional medical testing may be required.

Special Considerations for Specific Epileptic Syndromes

The FAA recognizes that some childhood-onset epilepsy syndromes, such as Self-Limited Epilepsy with Centrotemporal Spikes (SeLECTS), have a high likelihood of full remission. For applicants with a history of this condition:

• A four-year seizure-free period is required.
• The last two years must be medication-free.
• The same medical evaluations apply as for a single unprovoked seizure.

If the applicant meets these criteria, certification may be possible under a Special Issuance.

The FAA Special Issuance Process

For cases that do not meet standard certification criteria, the FAA may consider granting a Special Issuance medical certificate. This process involves:

1. Comprehensive Medical Review – The FAA reviews all submitted medical documents, neurological evaluations, imaging results, and EEG studies.
2. Additional Testing – The FAA may request further testing, extended observation, or consultation with additional specialists.
3. Periodic Medical Monitoring – If a Special Issuance is granted, the FAA may require ongoing medical follow-ups, including periodic EEGs and neurological assessments.
4. Case-by-Case Decision – Each application is reviewed individually, considering the risk of seizure recurrence and the applicant’s overall health status.

Key Takeaways for Pilots Seeking Certification

• Simple febrile seizures occurring before age 5 and fully resolved may allow immediate certification.
• Single provoked seizures require a one-year seizure-free period and extensive medical testing.
• Single unprovoked seizures require a four-year seizure-free period, with the last two years medication-free.
• Epilepsy diagnosis requires a ten-year seizure-free period, with the last three years medication-free.
• All cases require a neurological evaluation, EEG, MRI, and FAA Seizure Questionnaire before the FAA will consider certification.
• The Special Issuance process may allow case-by-case approvals for qualified applicants.

Final Thoughts

Seizure disorders present significant challenges for FAA medical certification, but under specific conditions, pilots can regain their eligibility to fly. The key is adherence to FAA guidelines, working closely with medical professionals, and ensuring a thorough and accurate submission of medical records.

If you are seeking FAA medical certification after a seizure diagnosis, consulting with an Aviation Medical Examiner (AME) and a neurologist familiar with FAA regulations can improve your chances of a successful outcome. Understanding the certification process and following all required steps carefully can help pilots return to the skies safely and legally.