As a neurologist in Dallas near one of the busiest airports in the world, Alison Leston, M.D., Ph.D., Section Head of General Neurology at UT Southwestern, has gained extensive experience caring for pilots and helping them meet federal health requirements for flying. Her growing reputation as one of the few specialists in a field known as aviation neurology has attracted referrals of pilot patients from across the country.

Pilots must meet stringent “fitness to fly” requirements set by the Federal Aviation Administration (FAA) to maintain their flying certification. They must undergo periodic flight physicals with an aeromedical physician. Neurological symptoms will be referred to a specialist, like Dr. Leston, for further evaluation. She now sees multiple pilots per week, and the number is growing steadily.

Dr. Leston cares for pilots as a specialist in aviation neurology.

Seeing a neurologist who is familiar with FAA regulations is important to pilots for whom a poor diagnosis or wrong medication could mean the end of a career, said Dr. Leston, who also serves the FAA as a member of the Federal Air Surgeon’s neurology panel.

“Pilots suffer from the same neurological issues as the general population, but in addition, they seem to have more head injuries,” said Dr. Leston, Associate Professor of Neurology and member of the Peter O’Donnell Jr. Brain Institute. “When I evaluate pilots and write up their reports, it’s similar to a report for any other patient, except that I know the FAA will be reading it so I use their language.”

For example, pilots are not allowed to take any medications labeled “may cause drowsiness,” which means that even an over-the-counter drug for seasonal allergies is off limits. “Often my work with pilots includes reducing their migraines with FAA-approved meds, like beta-blockers and calcium-channel blockers,” said Dr. Leston. “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 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,” said 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.”

Dr. Leston earned her medical degree at Washington University School of Medicine in St. Louis and holds a doctoral degree in neurobiology from the University of Chicago. She joined the UT Southwestern faculty in 2014. She became interested in aviation neurology as a subspecialty after moving to Dallas and meeting pilots within her social circle. “The more pilot patients I see, the more knowledgeable I become,” she said. “I’m also an active member of the Aerospace Medicine Association and the Civil Aviation Medical Association, where I’m involved in providing CME to physicians who administer flight physicals.”