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O'Donnell Brain Institute’s Aviation Neurology Program Ensures Top-flight Pilot Performance

Alison Leston, M.D., Ph.D., Section Head of General Neurology and Headache at UT Southwestern

Alison Leston, M.D., Ph.D., Section Head of General Neurology and Headache at UT Southwestern

At UT Southwestern Medical Center, we have access to one of the busiest airports in the world (DFW International Airport) and can spot planes landing at Dallas Love Field out of windows in the Aston Building. This proximity ensures that the Neurology Department’s Aviation Neurology Program stays busy with its focus on clearing pilots to fly.

Alison Leston, M.D., Ph.D., Section Head of General Neurology, has led institutional efforts to support aviation medicine and cares for numerous pilots, helping them meet federal health requirements for flying. An expert in the clinical treatment of headaches, Dr. Leston’s growing reputation as one of the few specialists in aviation neurology has attracted referrals of pilot patients from at least 18 states, including Hawaii.

Pilots must meet stringent "fitness to fly" requirements set by the Federal Aviation Administration (FAA) to maintain their certification, including undergoing periodic flight physicals with an aeromedical physician. Those who have neurological symptoms are referred to a specialist like Dr. Leston for further evaluation. She sees multiple pilots per week and has worked with more than 200 pilots with neurological conditions.

Seeing a neurologist who is familiar with FAA regulations is important. Being prescribed the wrong medications could mean the end of a career. For example, pilots are not allowed to take any medications labeled "may cause drowsiness," which means that even cetirizine (Zyrtec) and most antidepressants are off-limits. Diphenhydramine is the substance most often found in toxicology reports following aircraft accidents.

"Often my work with pilots includes reducing their migraines with FAA-approved meds, such as beta blockers and calcium-channel blockers," Dr. Leston says. "Certain other medications can be used for acute treatment of migraines, but they may require waiting 24 to 48 hours to fly."

There are also high standards for clearing pilots who have experienced a head injury or loss of consciousness.

"If you or I briefly pass out or fall off a mountain bike, we might go to our local ER and be evaluated by the doctor there, who might tell us we can return to work," notes Dr. Leston. "But if you're a pilot, those of us in the back of the airplane want to be sure you don't develop post-traumatic seizures, so there will be a waiting period and often a required normal MRI before you're allowed to fly again. Knowing the regulations allows me to order the appropriate testing and get pilots back in the air sooner.”

The UTSW Aviation Neurology Program collaborates with other sections of the O'Donnell Brain Institute. Dr. Leston is often asked to write a summary report for a pilot who has recovered from neurosurgery. Stroke and epilepsy specialists have been asked to estimate the risk of stroke or seizure for a pilot seeking medical clearance. Several pilots have undergone therapy after a stroke or traumatic brain injury with our colleagues in the Department of Physical Medicine and Rehabilitation before returning to the cockpit. The flying public should be reassured that pilot performance is, on average, well above that of the general population.