Sports and Activities
Exercise is good for everyone, but it also has important benefits for people with epilepsy.
Seizures during sports activity are rare, and exercise may benefit those with epilepsy, but physicians, coaches, and parents should know what to do if a seizure occurs. Most sports activities are acceptable as long as people avoid overexertion, dehydration, and hypoglycemia (low blood sugar).
Striking a safe balance between the epilepsy, its treatment, and appropriate physical activity recommendations can bring people important health benefits.
Exercise and epilepsy
People with epilepsy and their families are commonly concerned about seizures during exercise. Fear often results in overprotection, feelings of isolation, and needless activity restrictions. So an understanding of how exercise affects both epilepsy and seizures is important.
Seizures during exercise are rare. If seizures occur, it is most likely after the exercise (15 minutes to 3 hours after exercise). Very occasionally, people can have seizures that are triggered by exercise.
Epilepsy may improve with exercise. Although the reasons are unclear, studies demonstrate that abnormalities on EEG decrease during exercise.
Increased attention and awareness needed during exercise may be a reason for the EEG improvement. One study speculated that this increased mental concentration may reduce seizure frequency. How increased awareness might protect against seizures is unknown.
One study showed that physical exercise had no harmful effects for people with epilepsy, and a considerable proportion of people (36%) claimed that regular exercise contributed to better seizure control. However, in approximately 10% of people, exercise appeared to precipitate seizures, and this particularly affected people with partial epilepsy.
Overall fitness and a feeling of well-being have been shown to help reduce seizure frequency. People feel better and improve their seizure control with regular exercise. One report suggests that exercise improves self-esteem and social integration regardless of seizure control. It has also been shown that regular exercise reduces the number of overall health complaints, such as muscle pains, sleep problems, depression and fatigue.
Medications and exercise
Antiepileptic drugs (AEDs) are the most common treatment for epilepsy and seizures, but most have side effects that cause fatigue and tiredness, which is a problem for active people. Other side effects--blurred or double vision, concentration difficulty, and impaired coordination--can also influence sports performance.
Some medications can contribute to poor physical fitness. Valproic acid and lamotrigine may cause weight gain, but a regular exercise program may cancel this effect. Antiepileptic drug selection must consider individual concerns.
Physical training appears to affect blood levels of certain AEDs. Thus, blood AED levels of people who have regular exercise programs should be monitored, especially in the first few months of training. Additionally, athletes who have epilepsy should avoid anabolic steroids because they may alter AED blood levels.
For people who have had surgery for epilepsy, a rule of thumb for returning to exercise is to start gradually and avoid contact sports for 12 months. Preventing head trauma is essential, because the skull takes a long time to heal. Likewise, for people who have had vagus nerve stimulation, neck protection is essential to prevent damage to the generator pack and injury to the nerve.
Sports to undertake with caution
While we recommend leading a normal life and not isolating yourself, it is important to consider your safety and the safety of others if you are thinking of participating in any of the below sports, particularly if your seizures aren't fully controlled.
- Full-contact karate
- Solo hang gliding
- Solo parachuting
- Unsupervised mountain climbing
- Aviation sports
- Gymnastics (parallel bars, uneven bars)
- Horseback riding
- Ice hockey, ice skating
- Motor sports
- Mountain climbing
- Scuba diving
- Unsupervised downhill skiing
- Unsupervised sailing
- Unsupervised water sports and swimming
- Wind surfing
Returning to sport after a having a seizure
A common question is how soon can someone return to play after a seizure?
After a person’s very first seizure, a thorough neurologic assessment is needed. If the seizure was provoked by another condition such as metabolic disorder, alcohol, infection, tumor, or abscess, the person can return to play after treatment of that particular condition.
If seizures have an unknown cause, limitations will depend on how well seizures are controlled. There is no specific waiting period before return to physical activity. Common sense and sound judgment should prevail.
Tips when playing sport
- Wear the right protection during contact sports or physical activity, eg. helmet
- If it is possible a seizure may occur, wear a medical alert bracelet, so people can easily identify you have epilepsy and don't over-react
- Tell the coach and possibly teammates that you have epilepsy
- Ask the doctor whether certain sports are appropriate for you
- Keep yourself well hydrated and drink or snack on something with sugar in it
- DON'T continue exercising if you feel faint, lightheaded, nauseous, or dehydrated
- DON'T overexert yourself, know your limits
- DON'T take anabolic steroids as they can also alter the effects of medications
- Physical Activity and Epilepsy. What Are the Rules? Joseph I. Sirven, MD; Jay Varrato, DO The Physician And Sportsmedicine - Vol 27 - No. 3 - March 1999