Role of Physical Activity and Exercise in Alleviating Cognitive Impairment in People With Epilepsy

Abstract

Many persons with epilepsy (PWE) experience problems with a wide range of cognitive functions, including learning, memory, attention, and executive control. These deficits in cognition result in diminished quality of life for PWE and are related to many factors, including the etiology of their epilepsy, recurrent seizures, side effects of antiseizure medications, or a combination of these factors. Various treatments to ameliorate cognitive deficits experienced by PWE have been implemented, although noninvasive and nonpharmacologic strategies may be more appealing options due to their relatively low cost, reduced risk of side effects, and/or reduced potential interactions with antiseizure medications. Physical activity and exercise may improve cognition in PWE but have not been well researched in this respect. To date only 1 study has directly investigated the effects of exercise on cognition in PWE, and it showed improved performance on tests of attention and executive function. The goal of the present article was to examine how increased physical activity and exercise contributes to 3 strategies (reducing seizure frequency, reducing epileptiform discharges, and decreasing symptoms of depression) that have been described as having a positive impact on cognition in PWE, as well as highlight related findings in experimental models of epilepsy. There is a definite need for more randomized controlled trials to establish greater clinical evidence for the use of physical activity and exercise in ameliorating cognitive impairment in PWE. We also need to better understand the factors contributing to reduced physical activity in PWE, as well as ways to overcome such barriers. With the available research in the area of exercise in epilepsy showing positive results, and a supportive research climate encouraging PWE to engage in greater physical activity overall, further investigations into the relationships between physical activity and cognition in epilepsy are warranted.

High mobility group box 1 (HMGB1) as a novel frontier in epileptogenesis: from pathogenesis to therapeutic approaches

“…Moreover, HMGB1 has been implicated in memory impairment by mediating the effects of RAGE and TLR4 (Mazarati et al 2011). An earlier study alarmingly revealed that one half of PWE exhibit cognitive dysfunctions (Jensen 2011) in one or more domains, including learning, memory, attention, and executive functioning, though memory impairment is the most common (Allendorfer and Arida 2018). Currently, there is no anti-seizure drugs available with dual effects that can retard seizure frequency as well as improve associated cognitive dysfunction.…”

Dietary and Lifestyle Behavior in Adults With Epilepsy Needs Improvement: A Case-control Study From North-eastern Poland

“…In general, fewer people with epilepsy show physical activity at the recommended level [44]. Importantly, other studies address the potentially bene cial role of physical activity in improving the cognitive function of patients with epilepsy [73] and quality of life [74]. Scienti c evidence indicates that it is reasonable to educate patients with epilepsy about their lifestyle.…”

Effect of combined physical training on cognitive function in people with epilepsy: Results from a randomized controlled trial

“…Nevertheless, to date, few studies have examined the effect of physical exercise on cognitive function in adults with epilepsy 13,15 . Strategies to reduce the burden of common adverse effects such as cognitive impairment in people with epilepsy must be developed 3,16,17 . Thus, this study aimed to examine the effect of a 12‐week exercise program on cognitive function in people with epilepsy.…”