McGuire Stephen A, Marsh Royden W, Sowin Timothy W, Robinson Andrew Y
U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH, USA.
Aviat Space Environ Med. 2012 Feb;83(2):140-3. doi: 10.3357/asem.3104.2012.
Traumatic brain injury (TBI) is common in young adults and therefore of significant concern to an aircrew population. This paper reports the occurrences of seizures in U.S. Air Force (USAF) aircrew following receipt of an aeromedical waiver for TBI.
Using both an aeromedical waiver tracking system database and medical records, we identified surrogate seizure markers such as all episodes of subsequent TBI, seizure, loss of consciousness, or prescription of anticonvulsant medications from the time of initial TBI until the last medical visit or entry recorded in either the database or medical records for our study population.
The seizure rate for aircrew who met USAF waiver criteria was 24.53/100,000 person-years. One pilot experienced a major motor seizure 14.9 yr following a severe TBI for an incidence of 308.64/100,000 person-years.
The USAF waiver process following TBI was sufficiently effective in removing aircrew with elevated risk for seizure following TBI. While our rates of post-traumatic seizure appear to be lower than previously published civilian population rates, direct comparison cannot be made secondary to differences in study design and selection criteria. Further areas of study could involve a more detailed analysis of aircrew neurocognitive status following TBI for subtle changes, crosschecking USAF Safety Center data for changes in accident rates among post-TBI aircrew, and analysis of lost aircrew flying time as a result of TBI and the degree of burden that loss places on the flying mission.
Application of these stringent criteria is sufficient to fulfill aeromedical safety standards, but costs remain undetermined.
创伤性脑损伤（TBI）在年轻成年人中很常见，因此受到空勤人员的高度关注。本文报告了美国空军（USAF）空勤人员在获得TBI航空医疗豁免后癫痫发作的情况。
我们使用航空医疗豁免跟踪系统数据库和医疗记录，确定了替代癫痫发作的标志物，例如从初始TBI发生之时起至我们研究人群在数据库或医疗记录中最后一次就诊或记录之时的所有后续TBI发作、癫痫发作、意识丧失或抗惊厥药物处方。
符合美国空军豁免标准的空勤人员癫痫发作率为24.53/100,000人年。一名飞行员在严重TBI后14.9年经历了一次大发作性癫痫，发病率为308.64/100,000人年。
TBI后的美国空军豁免程序在排除TBI后癫痫发作风险较高的空勤人员方面足够有效。虽然我们的创伤后癫痫发作率似乎低于先前公布的 civilian population rates，但由于研究设计和选择标准的差异，无法进行直接比较。进一步的研究领域可能包括更详细地分析TBI后空勤人员的神经认知状态以发现细微变化、交叉核对美国空军安全中心关于TBI后空勤人员事故率变化的数据，以及分析TBI导致的空勤人员飞行时间损失及其对飞行任务造成的负担程度。
应用这些严格标准足以满足航空医疗安全标准，但成本仍未确定。
