TP 13312

•	Foreword
•	Section 1
•	Section 2
•	Neurology
•	Cardiovascular
•	Diabetes
•	Asthma
•	Other Policies
•	Contacts
•	Alternate Formats

Multiple Sclerosis

• General
• Flight Safety Concerns
• Recommendations

General

Multiple Sclerosis (MS) has a prevalence of about one in a thousand in Canada. The peak incidence is in the early 30’s with more females than males being affected. It is the third most common cause of severe neurological impairment in the 15-60 year age range. The course is variable. Some will have a relapsing, remitting course and 20 - 30% will have a benign course. Fatigue is one of the most disabling problems in patients with multiple sclerosis. In 60% of the patients the symptoms are exacerbated by an elevated ambient temperature.

Flight Safety Concerns

1. Functional Disabilities 
     
   Though many of these will be readily apparent from a practical flight test, (eg. weakness, lack of coordination etc.) they also include problems with excessive glare in bright light and increased levels of fatigue.
     
2. Neuropsychological Deficits
     
   40% of the patients with MS have been found to have neuropsychological problems. This is significantly but weakly correlated with the degree of functional disability.
     
3. Paroxysmal Events
     
   Epilepsy occurs in 5% of patients with MS. Trigeminal Neuralgia is commonly a symptom of MS when it occurs in the young. Paroxysmal dysfunction of motor or sensory systems may occur with this disease.

Recommendations

1. Functional Disabilities
     
   Individuals with functional disabilities that interfere with the mechanics of flying or those who have a progressive course of MS will be considered unfit. This is also true of those who suffer significant fatigue or heat sensitivity. Individuals who have a remitting/relapsing course may be considered fit when they have been in remission for three months provided the remission is complete or with minimal residua (eg. Expanded Disability Score of less than 2 on a scale of 0 - 10). Such individuals will require neurological follow-up every six months.
     
2. Neuropsychological Sequelae
     
   Because of the concern for subtle neuropsychological deficits, applicants should probably be followed by a neurologist with expertise in M.S. Neuropsychological testing should be considered periodically especially in those who have significant fluctuation in symptoms. Flight simulator testing may be useful in assessing cognitive function. The role of MRI to delineate those who may have neuropsychological deficits has not been defined at this time. Those with marked involvement of the white matter with MS plaques, particularly if the involvement is bifrontal, should have neuropsychological testing and, if indicated, a practical flight test. 
     
3. Paroxysmal Events
     
   1. Epileptic Seizures 
       
      These individuals are permanently unfit.
        
   2. Trigeminal Neuralgia
        
      Applicants are unfit during periods when they are symptomatic. It is unusual for these to resolve and most continue to be unfit.
        
   3. Other Paroxysms
        
      Usually these are of limited duration. If they resolve and are absent for four months off medication the individual can be reconsidered for medical certification.