British Rowing Epilepsy Safety

I recently received an enquiry from a rowing coach who had an athlete with the condition and looking at the current British Rowing guidance on “Rowing and Epilepsy”, he sought a few clarifications. At first glance, the online BR advisory seems to prohibit rowing for individuals who have suffered a seizure in the past year, but such an interpretation overlooks a critical part of the advice which notes that a “special individualized risk assessment of the individual and the event” is an important consideration. I coach an athlete who has had seizures (including one on the water) and we have accommodated his continued rowing with a risk assessment and individual protocol tailored to his situation.

The enquiry led to an examination of the “Rowing and Epilepsy” advice where I “phoned a friend” (my wife) Lori Lynn who headed up the Therapy Department at the UK Epilepsy for a number of years (and is a rower), as well as her former colleague Prof. Matthias Koepp, Professor of Neurology Clinical & Experimental Epilepsy at UCL Queen Square Institute of Neurology (and who also happens to be a rower). They both provided British Rowing’s Honorary Safety Advisor Stephen Worley with more detailed input into the considerations of rowing with epilepsy. Their key clarification was how diverse seizures are. While some can be very dangerous in situation like being on the water, others could be quite manageable with appropriate safeguarding measures (eg. appropriately briefed and capable support rower, auto-inflate life jacket).

As a result of the very productive discussion, Stephen Worley published the following added advice about rowing with epilepsy in his most recent British Rowing safety report:

A rower wrote to ask for clarification on the British Rowing guidance on Rowing and Epilepsy. This contains the following: –

In line with the recommendations of the DVLA, this period of significant risk is defined as within one year following a seizure, and for six months whilst reducing medication or stopping medication. In these cases, where there is significant risk of further seizures, rowers, coaches (driving launches) and coxswains should not be allowed on the water, except where there is a special individualised risk assessment of the individual and the event.

This was interpreted to mean that, to row, an individual must go a year without seizures on medication, and a further 6 months with no seizures without medication. This is not what was intended.

In fact, the guidance says that the “at risk” period is reduced from one year to six months if the rower is seizure free whilst reducing OR stopping medication. Also, it does not require the rower to have stopped medication. If the rower has been seizure free for a year even while taking medication, then they are able to row.

It has been explained to me that Epilepsy is a syndrome rather than a disease. It presents in many different forms in different people. We need to be able to accommodate the variety of experiences that different people have. It is for this reason that the guidance also mentions “a special individualised risk assessment of the individual and the event”. “Event” in this context could also be described as the venue and circumstances in which the person rows.

In my view, much of this personalised risk assessment should be based on information from the rower’s medical team on the probability of the rower having a seizure afloat and the type and severity of that seizure. The risk assessment may also include the steps that the rower, and their club, can take to minimise the harm that would result if the rower had such a seizure. This could include ensuring that they row in crew boats with people who are willing to support and assist them if needed.