High-Altitude Medical

HANDBOOK

About 3% of the population has epilepsy, and 10% of people experience at least one seizure in their lifetime.

CAUSES OF SEIZURES AT HIGH ALTITUDE

Seizures (including a first-ever seizure) may be triggered by:

➤ High-altitude cerebral edema (HACE) – rarely a direct cause of seizures,

➤ Sleep disturbances – lack of sleep, fragmented sleep, interrupted breathing during sleep,

➤ Acclimatization process,

➤ Hyperventilation – hypocapnia may increase neuronal excitability,

➤ High-altitude hypoxia.

BEFORE THE EXPEDITION

If you have epilepsy:

➤ Ensure your condition is well-controlled and stable.

➤ There should be at least 6 months without seizures before the trip.

➤ Poorly controlled epilepsy is a relative contraindication for high-altitude travel.

Be aware of the risks related to climbing and belaying. Make sure your expedition partners understand these risks, as a seizure during climbing may be life-threatening.

Check whether any antimalarial medications interfere with your antiepileptic therapy.

AT HIGH ALTITUDE

➤ Avoid illnesses that may affect treatment efficacy.

➤ Avoid known seizure triggers (e.g., alcohol, fatigue).

➤ Antiepileptic drugs may affect sleep and impair coordination.

➤ After a seizure, rest is essential.

For individuals with epilepsy or those who experience a seizure at altitude, seizure prophylaxis is recommended:

➤ Acetazolamide 125–250 mg twice daily for 1–2 days before exposure and then throughout the stay.

Those who have previously taken antiepileptic medication should continue therapy during the trip – seizure frequency at altitude usually does not increase.

MANAGEMENT OF SEIZURES

If a seizure occurs during the expedition:

➤ Descend to a lower altitude and return home.

➤ Seizure prophylaxis during descent:

- Acetazolamide twice daily,

- Lorazepam 1–2 mg every 12 hours for 3–4 days.

Example: A 50-year-old woman experienced her first generalized seizure after landing in La Paz (4,100 m), likely triggered by altitude.

For those who have had a seizure at altitude and must fly again, prophylactic Lorazepam just before the flight is recommended – a single oral dose of 1–2 mg (duration ~12 hours).

SUMMARY

➤ Control your epilepsy before and during the expedition.

➤ Inform your companions about your condition and seizure management.

➤ Plan pharmacologic prophylaxis (Acetazolamide, Lorazepam).

➤ In case of a seizure – descend and rest.

REFERENCES

• Travel at High Altitude – www.medex.org.uk

• K. Mieske et al., Journeys to High Altitude—Risks and Recommendations for Travelers with Preexisting Medical Conditions, Journal of Travel Medicine, 2010; 17(1): 48–62

• R. W. Baumgartner et al., Going High with Preexisting Neurological Conditions, High Altitude Medicine & Biology, 2007; 8(2): 108–117

• E.H. Maa, How Do You Approach Seizures in the High Altitude Traveler?, High Altitude Medicine & Biology, 2011; 12(1): 13–19

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WANT TO LEARN MORE?

If you want to better prepare your health for trekking or a high-altitude expeditions, check out the expanded guide in the ebook "High-Altitude Medicine for Trekkers and Climbers" >>

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Gain practical skills for handling emergencies in the mountains through our online training "High-Altitude First Aid" >> - prepared for those planning trips to high altitudes.

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 For a detailed list of what to include in your expedition medical kit and step-by-step instructions for assembling your personal first aid set, see the ebook "High-Altitude Expedition Medical Kit Guide" >>

PLANNING A TREK OR A HIGH-ALTITUDE EXPEDITION?

If you would like to check whether your health condition allows you to safely participate in a trek or high-altitude expedition, consider booking a medical consultation >> or using a telemedical expedition package >>

This allows you to assess potential health risks in advance, prepare properly fot altitude, and increase your safety during the expedition.

The company was established in 2004. The goal of MedEverest is education in the field of mountain medicine and the dangers of high altitudes. I deal with all medical aspects of staying at high altitude. I organize medical support for trekking and high-altitude expeditions.

Specialist Medical Practice Medeverest Robert Szymczak based in Gdańsk (80-360), at ul. Bolesława Krzywoustego 19F, NIP: 5841943576, REGON: 220148318.

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