Epilepsy Action of Australia

Exercise and Epilepsy
Medications and Exercise
Sports to undertake with caution
Returning to sport after a seizure
Tips when playing sport

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.

How Epilepsy Medications Affect 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.

Examples of sports to undertake with caution, especially if you have difficulty with seizure control

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.

Boxing
Full-contact karate
Unsupervised scuba diving
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
Waterskiing
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 someones 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

Read cyclists Rhys Williams personal experience with epilepsy Cycle of Life

Reference
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

http://www.physsportsmed.com/issues/1999/03_99/sirven.htm

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