Epilepsy and physical exercise

Abstract

Epilepsy is one of the commonest neurologic diseases and has always been associated with stigma. In the interest of safety, the activities of persons with epilepsy (PWE) are often restricted. In keeping with this, physical exercise has often been discouraged. The precise nature of a person's seizures (or whether seizures were provoked or unprovoked) may not have been considered. Although there has been a change in attitude over the last few decades, the exact role of exercise in inducing seizures or aggravating epilepsy still remains a matter of discussion among experts in the field. Based mainly on retrospective, but also on prospective, population and animal-based research, the hypothesis that physical exercise is prejudicial has been slowly replaced by the realization that physical exercise might actually be beneficial for PWE. The benefits are related to improvement of physical and mental health parameters and social integration and reduction in markers of stress, epileptiform activity and the number of seizures. Nowadays, the general consensus is that there should be no restrictions to the practice of physical exercise in people with controlled epilepsy, except for scuba diving, skydiving and other sports at heights. Whilst broader restrictions apply for patients with uncontrolled epilepsy, individual risk assessments taking into account the seizure types, frequency, patterns or triggers may allow PWE to enjoy a wide range of physical activities.

Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy

“…Engaging in physical exercise and sport activities has positive medical and psychosocial effects for PWEs, including increased self‐esteem, socialization, and improvement in long‐term general health. However, historically, restrictions have often hampered the participation of PWEs in sports . There are limited data as to which sports involve specific risks for PWEs and how specific risks vary in relation to seizure frequency and seizure type.…”

“…Factors to be considered include not only the type of sport and the probability of a seizure occurring, but also individual characteristics such as the type and severity of the seizures, the consistency of any prodromal manifestations, the history concerning any seizure‐precipitating factors, the likelihood of effective supervision by family members or other personnel, and the willingness of the informed PWE (or parents) to take a reasonable level of risk. A careful medical history is essential to ascertain not only the frequency and characteristics of the seizures, but also any previous seizure‐related accidents or injuries, duration of periods of seizure freedom, and degree of adherence to treatment . Therefore, choosing a specific physical exercise/sport for a person with epilepsy requires consideration of personal attitudes and preferences, health status, as well as medical advice.…”

“…People with epilepsy (PWEs) have been advised often against participating in sports and exercise, mostly because of fear, overprotection, and ignorance about the benefits and risks associated with such activities . Although the implications of engaging in sports and physical exercise for PWEs have been extensively debated, several studies reported that in most cases these activities can have a beneficial influence on seizure frequency and severity . As a result, attitudes regarding sports and epilepsy have changed considerably in the last decades, as have recommendations in clinical practice .…”

“It's such a vicious cycle”: Narrative accounts of the sportsperson with epilepsy

“…As one of the most common neurological disorders, epilepsy affects 50 per 100,000 people in the UK per year and 50 million people worldwide (Aydemir, Vu Trung, Snape, Baker, & Jacoby, 2009). Research has shown physical activity to be beneficial for most people with epilepsy (PWE) because of its positive effects on seizure control and personal well-being (Pimental, Tojal & Morgado, 2015). However, PWE experience many barriers to exercising with epilepsy.…”

“…As a consequence of this on-going hindrance, and despite the specific physical and mental benefits of physical activity, exercise is still not a regular occurrence for PWE (Dubow & Kelly, 2003). The resultant inactivity levels have shown to contribute to social isolation, low selfesteem, weight gain, and depression for people with epilepsy (Pimental et al, 2015).…”