Exercise as it relates to Disease/The effects of physical activity on the symptoms of epilepsy

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Background[edit]

What is Epilepsy?[edit]

Epilepsy is a group of neurological disorders characterized by persistent and unpredictable epileptic seizures.[1][2][3] These seizures are caused by excessive or abnormal neuronal activity in the brain.[1][3][4] Diagnosis of epilepsy requires a medical history of only one seizure if the patient shows signs of an enduring alteration in the brain that increases the probability of seizures in the future.[1][4][5]

Causes[2][edit]

  • Congenital/genetic disorders
  • Acquired through head trauma or infection
  • Toxic disorders (alcohol and drugs)

Prevalence[edit]

Epilepsy is a very common neurological disorder affecting almost 2% of the world’s population.[2][4][5][6] This accounts for approximately 50 million people worldwide.[2][3] There are 100,000 new cases are reported in the US every year and in the UK there are around 1 in 140 people being treated for epilepsy.[2] Temporal lobe epilepsy is the most common form of epilepsy accounting for 20% of all diagnoses.[2]

Treatments[edit]

The most common treatment for epilepsy is the use of anti-epileptic drugs (AEDs).[3][4][7][8][9] This type of treatment tends to be long term and suppresses seizures.[3][4][7][8][9] However non-pharmacological treatments or complimentary therapies include surgery, vagal nerve stimulation, ketogenic diet, yoga and electroencephalography.[10]

Physical Activity[edit]

People with epilepsy are often discouraged from participating in physical activity by health professionals and family members, in case of exercise induced seizure.[2][7][8][9][11][12][13][14][15] However, the occurrence of exercise induced seizures are quite rare.[2][7][8][9][11][12][13][14][15] This is a major contributor to the lower physical activity levels in people with epilepsy compared to the general population.[2][6][8][9][12][15] This puts them at a greater risk of obesity and related co-morbidities.[2][6][12] Physical activity appears to reduce the occurrence of seizures and improve other areas of health including cardiovascular health, weight control and bone health.[2][7][8][12][13][14][15] Depression and anxiety are common in epileptic populations and there is strong evidence to suggest that participation in physical activity has a positive effect on these conditions.[2][7][8][14][15]

Barriers[2][6][8][9][12][15][edit]

  • Fear of seizure
  • Fatigue from medications
  • Social isoloation
  • Fear of attracting attention
  • Lack of transport
  • Lack of accommodative facilities
  • Fear of the lack of qualified professionals

Types of Exercise and Their Effect[edit]

Type of Physical Activity Hypothesised Effect
* Anaerobic[13]
* Moderate Intensity Aerobic[7][9][13]
* Yoga[10][13][14][15]
* General Physical Activity.[13][14]
* Decreases blood pH which reduces the effectiveness of specific enzymes which may have an anti-convulsive effect
* Produces β-endorphins which are believed to inhibit epileptic discharges
* reduced stress and in turn reduced incidence of stress induced seizure
* Associated with an increase in mental alertness could contribute the rarity of exercise induced seizures

Risks[edit]

Hyperthermia, hyponatremia, stress, hypoxia, hyperhydration and hypoglycaemia are all known triggers for epileptic seizures and can be linked to prolonged exercise in hot, humid conditions or high altitudes.[2][9][13]

Recommendations[edit]

It is hard to make generalized recommendations for physical activity as epilepsy encompasses large number of diseases.[2][9] Recommendations must take into account frequency and type of seizures occurring as well as general medical history.[2][9] However, most sports are deemed safe for epileptic patient participation, though some may need more supervision eg. water sports.[2][6][9] Patients with good seizure control should be able to participate in both non-contact and contact sports as there is little evidence showing that repeat minor head trauma will increase the incidence of seizure.[2] The psychological stress of the type of physical activity should also be considered.[13]

Further reading[edit]

References[edit]

  1. a b c Fisher, R., Emde Boas, W., Blume, W., Elger, C., Genton, P., Lee, P., & Engel, J. (2005). Epileptic Seizures and Epilepsy: Definitions Proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46(4), 470-472. doi: 10.1111/j.0013-9580.2005.66104.x
  2. a b c d e f g h i j k l m n o p q r Arida, RM., Cavalheiro, EA., Silva, AC. & Scorza, FA. (2008). Physical Activity and Epilepsy: Proven and Predicted Benefits. Sports Medicine 38(7), 607-615. doi: 10.2165/00007256-200838070-00006
  3. a b c d e Meyer, AC., Dua, T., Ma, J., Saxena, S., & Birbeck, G. (2010). Global disparities in the epilepsy treatment gap: a systematic review. Bulletin of the World Health Organization, 88(4), 260-266. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862010000400011&lng=en&tlng=en. 10.1590/S0042-96862010000400011
  4. a b c d e Douw, L., Groot, M., Dellen, E., Heimans, JJ., Ronner, HE., Stam, CJ. & Reijneveld, JC. (2010). ‘Functional Connectivity’ Is a Sensitive Predictor of Epilepsy Diagnosis after the First Seizure. PLoS ONE 5(5). doi: 10.1371/journal.pone.0010839
  5. a b Blume, WT. (2003). Diagnosis and Management of Epilepsy. CMAJ 168(4), 441-448. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143552/
  6. a b c d e Wong, J. & Wirrel, E. (2006). Physical Activity in Children/Teens with Epilepsy Compared with That in Their Siblings without Epilepsy. Epilepsia 47(3), 631-639. doi: 10.1111/j.1528-1167.2006.00478.x
  7. a b c d e f g Arida, RM., Scorza, FA., Silva, SG., Schachter, SC. & Cavalheiro, EA. The Potential Role of Physical Exercise in the Treatment of Epilepsy. Epilepsy and Behaviour 17(4), 432-435. doi: 10.1016/j.yebeh.2010.01.013
  8. a b c d e f g h Ablah, E., Haug, A., Konda, K., Tinius, AM., Ram, S., Sadler, T. & Liow, K. (2009). Exercise and Epilepsy: A survey of Midwest Epilepsy Patients. Epilepsy and Behaviour 14(1), 162-166. doi: 10.1016/j.yebeh.2008.09.019
  9. a b c d e f g h i j k Nakken, KO. (2007). Clinical Research Physical Exercise in Outpatients with Epilepsy. Epilepsia 40(5), 643-651. doi: 10.1111/j.1528-1157.1999.tb05568.x
  10. a b Saxena, VS., Nadkarni, VV. (2011). Nonpharmacological Treatment of Epilepsy. Ann Indian Acad Neurol 14(3), 148-152. doi: 10.4103/0972-2327.85870
  11. a b Mcauley, JW., Long, L., Heise, J., Kirby, T., Buckworth, J., Pitt, C., Lehman, KJ., Moore, JL. & Reeves, AL. (2001). A Prespective Evaluation of the Effects of a 12-Week Outpatient Exercise Program on Clinical and Behavioural Outcomes in Patients with Epilepsy. Epilepsy and Behaviour 2(6), 592-600. doi: 10.1006/ebeh.2001.0271
  12. a b c d e f Arida, RM., Scorza, FA., Albuquerque, M., Cysneiros, RM., Oliveira, RJ. & Cavalheiro, EA. (2003). Evaluation of Physical Exercise Habits in Brazilian Patients with Epilepsy. Epilepsy and Behaviour 4, 507-510. doi: Evaluation of Physical Exercise Habits in Brazilian Patients with Epilepsy.
  13. a b c d e f g h i Arida, RM., Scorza, FA., Terra, VC., Scorza, CA., Almeida, AC. & Cavalheiro, EA. Epilepsy and Behaviour 16(3), 381-387. doi: 10.1016/j.yebeh.2009.08.023
  14. a b c d e f Arida, RM., Scorza, FA. & Cavalheiro, EA. (2010). Favorable effects of Physical Activity for Recovery in Temporal Lobe Epilepsy. Epilepsia 51(3), 76-79. doi: 10.1111/j.1528-1167.2010.02615.x
  15. a b c d e f g Arida, RM., Almeida AG., Cavalheiro EA. & Scorza FA. (2013). Experimental and Clinical Findings from Physical Exercise as Complementary Therapy for Epilepsy. Epilepsy & Behaviour 26(3), 273-278. doi: 10.1016/j.yebeh.2012.07.025