Article summary
Dr. Alison Reston, who lives near an American Airlines hub, has become a neurologist seeking referrals to see if pilots are fit to fly into the sky. Here she discusses the unique medical challenges and problems that pilots face.
Alison Reston, M.D., deliberately did not specialize in aeronautical neurology. It came naturally from hanging out with her pilot friends and learning their lingo, she said. Neurology Today.
By deciphering what happens in “sims” (flight simulation programs that pilots use to train) and deciphering the exact language required for the regular medical certifications required to fly, Dr. I became one of the few neurologists available. and the aviation industry.
She is a member of the Federal Aviation Administration’s (FAA) panel that reviews pilot aptitude from a neurological perspective, and a member of the Texas Department of Public Safety’s Medical Advisory Board, which serves a similar role with respect to driver licenses in Texas. Also a member. She is also active on the Civil Aviation Medical Association’s Board of Education, helps organize the annual meeting, and contributes to the Flight Physician newsletter. It’s all on top of her job as head of the General Neurology Section at the University of Texas Southwestern.
Dr. Leston was initially torn between the pursuit of clinical medicine and basic neuroscience research. She majored in biochemistry as an undergraduate at the University of Illinois and passed both medical school and graduate school. She first chose to devote herself to research in neuropharmacology, where she earned her doctorate in neurobiology from the University of Chicago.
Her paper focused on the structure of nicotinic acetylcholine receptors at the neuromuscular junction. This receptor is the target of attack in the autoimmune disease myasthenia gravis.
Although she enjoyed her studies, she wanted to work with patients and eventually went to medical school at Washington University in St. Louis. Thinking like her neuroscientist, she wrote her application to medical school in the form of signaling cascades. After a residency and her EMG Clinical Neurophysiology Fellowship in St. Louis, Dr. Leston practiced as a general neurologist and eventually became a partner.
“It all comes down to that medical certification. If a pilot is disqualified, their career is over, and they don’t have a lot of transferable skills. After medical school and residency and training, suddenly, Can you imagine being told you can never practice medicine again? That would be devastating.” – DR. Alison Reston
While in St. Louis, Dr. Reston began dating a pilot, they moved to the Dallas-Fort Worth area near the hub of American Airlines, and returned to their academic roots by taking a teaching position at UT Southwestern University. .
Many of her friends were pilots, so she heard about some of the challenges they faced. Benadryl is the most common substance found in the toxicology results of fatal plane crashes, she said.
At first, most of her referrals came from American Airlines, since she was near that hub. Rumors spread among the nurses of the Air Force, and she began receiving referrals from other airline pilots who needed evaluation.
“When they found out I spoke the pilot language, they started telling others that they should see me whenever they needed a neurologist,” she said. Dr. Reston sees professional and private pilots from all over the country. She now has half a day reserved for pilots at a neurology clinic.
The Role of Aviation Neurologists
Airline pilots are required to undergo a medical examination by an aviation medical examiner once a year until age 40, and then every six months, Dr. Leston explained. They must disclose any health issues or doctor’s appointments since the last flight physical.
“If a pilot is suspected of having neurological dysfunction, an aviation medical examiner cannot issue a medical certificate and leaves it to the FAA to make that determination,” Dr. Reston said.
“Most of my patients at the Aviation Neurology Clinic are pilots who have disclosed their neurological condition to an aviation inspector or union medical advisor. You may seek me out after receiving a letter from the FAA requesting a neurological evaluation.
On rare occasions, pilots are introduced by airlines. For example, to be promoted to fly larger aircraft, pilots must clock in hours using simulators. If they have not been able to keep up with new controls and technology and have failed to learn new skills, there may be a question whether it is a sign of early dementia. supervisors may be concerned that they need medical assistance.
“Those pilots will probably be referred to me for evaluation,” Dr. Reston said. “We discovered a neurodegenerative disease that way earlier than it would otherwise have been diagnosed without such stringent medical requirements.”
Some referrals, she said, relate to activities that pilots engage in off-time, and said pilots tend to be adrenaline junkies when they’re not in the air. Dr. Reston noted that the results could be very different from non-pilots, adding that it might be interesting to conduct research into whether there is an excess of head injuries in the pilot population.
“If you or I fall and hit our head, even if there is a moment of unconsciousness, we will probably get back to work soon. , you will have to disclose that you were injured, and the whole process will begin, which will proceed at the pace expected of a government agency.
“The pilot could be suspended for six months, up to five years, for more serious head injuries.
Aviation neurologists may be asked to focus specifically on conditions associated with sudden incapacitation. “My biggest concern is stroke and seizures. [a pilot]It’s fast enough to affect flight,” she said.
Pilots may be grounded for five years after a severe head injury to pass the time when they are most at risk of developing a post-traumatic seizure. “This is frustrating for pilots when they feel fully recovered from an injury and have never had a seizure,” she said.
An unfortunate aspect of airline life is that the job takes pilots away from home and family, Dr. Reston said. “I have seen many pilots who have been hospitalized during layovers far from home. Also, many people come to see me from out of state, so I often collect medical records from all over the world. Usually from a transit city where they first sought treatment and a hometown hospital where they received follow-up.The whole story wraps up in a report that the FAA uses to understand the case. is the reason you come to me.
Once a case comes to the attention of the FAA, a physician employed by the FAA will review the case. The FAA has just hired his second neurologist.
“FAA physicians may decide to issue or deny a medical certificate or request additional records or additional testing,” Dr. Leston said. “Sometimes they send letters to pilots asking them to resubmit their applications with a report from their neurologist. He may like someone and come to me.
For the most complicated cases, the FAA calls a panel of outside neurologists to discuss the case. Dr. Reston is a member of that committee, but he declines if he sees the pilot as a patient. “We review medical records, especially neurological examination reports. Decisions are as evidence-based as possible and refer to published data such as the risk of seizures and recurrent strokes in specific situations. is about how the available data apply to the specific aviator whose medical certificate is in question.”
“It all comes down to that medical certification. When a pilot is disqualified, their career is over and there are very few skills that can be transferred,” says Dr. Leston. “Can you imagine going all the way through medical school and resident training and suddenly being told you can never practice medicine again? It’s devastating.”
Current state of aviation neurology
Aeronautical neurology will work with the FAA to accept new migraine drugs that don’t cause drowsiness, or to determine whether new anticoagulants reduce the risk of atrial fibrillation-induced stroke sufficiently to get pilots back in the air. Either way, it’s an evolving field. “It’s a controversial issue,” she said.
Dr. Reston isn’t just interested in her area of expertise. Currently, she has 76 members in the International Aerospace Neuroscience Consortium, of which Dr. Reston is Vice-President. “This is a group of neurologists, neuropsychologists and related professionals working in aerospace medicine who come together to discuss research, policy, interesting cases, etc. Many of them work in military medicine. There are only a handful of private neurologists in the United States with whom U.S. pilots can actually book neurology consultations, either because they are on board or outside the U.S.,” Dr. Reston said.
She said the most important thing neurologists need to know about aviation neurology is that “determining flight suitability” isn’t just on their shoulders.
“They don’t have the authority to make that decision, but the FAA can’t see the pilots themselves, so they have to be the eyes and ears of the FAA,” Dr. Reston said.
“The FAA relies on a neurologist who has actually seen the patient, and that physician must have sufficient medical histories and documented examinations to allow the FAA to make decisions.” Doctors don’t make their own decisions, so they don’t have to be as intimidating as neurologists sometimes fear.
