Exercise or physical activity is good for general health and well-being and can provide long term health benefits for everyone. This can include better seizure control for people with epilepsy.
People with epilepsy and their families often have concerns about seizures happening during exercise which can result in needless activity restrictions. However, in general, the overall risk of injury in people with epilepsy does not appear to be higher than people without epilepsy, and physical activity is generally a good lifestyle choice.
Exercise and Epilepsy
Generally, it is uncommon to have seizures during exercise or sports activity. Approximately two percent of people with epilepsy have seizures that are triggered by exercise.
Most sports activities are okay as long as the person with epilepsy avoids anything that may increase their individual seizure risk such as overexertion, over-heating, dehydration, and low blood sugar (hypoglycemia).
There is evidence to support the assumption that sporting activity does not lead to an increase in seizures, but—if it has any effect at all—results in a reduction in the number of seizures.
(van den Bongard et al 2020)
There has been no link found between exercise related fatigue and an increase in seizures, but for some people there may be some possible seizure triggers associated with physical exercise such as; fatigue, stress, repeated head injury during contact sports, hyperventilation and electrolyte disturbances (dehydration).
A number of people report that their epilepsy improves with exercise.
Although the reasons are unclear, abnormalities on EEG decrease during exercise. Increased attention and awareness needed during exercise may be a reason for this EEG improvement. There is speculation that this increased mental concentration may reduce seizure frequency.
Overall fitness and a feeling of well-being have also been reported to help reduce seizure frequency. 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- which can contribute to improved seizure control.
Medications, treatment and exercise
Most people with epilepsy take antiepileptic medication.
These medications can have side effects that cause fatigue and tiredness. This can be a problem for active people, and can contribute to low motivation to get out and exercise. Other side effects can include weight gain, blurred or double vision and poor balance and coordination which can also impact sports performance.
For people who have had epilepsy surgery, a rule of thumb for returning to exercise is to start gradually and avoid contact sports for 12 months. The skull takes a long time to heal, so preventing head trauma is essential. Likewise, for people who have had vagus nerve stimulator (VNS) implanted. Neck protection is essential to prevent damage to the generator pack and injury to the nerve.
Performance enhancing drugs should be avoided because they may have unwanted side effects and may affect epilepsy medication blood levels – increasing the risk of seizures.
It goes without saying that people with poorly controlled seizures are at increased risk of injury during sport if a seizure occurs during a game. It is important that someone involved in the team – coaches, parents and possibly team mates – should know what to do if a seizure occurs.
For people with poorly controlled seizures the risks of injury or death are higher when participating in some activities (listed below).
Whilst we do not recommend participating in “high risk” activities, it is a personal choice, and if you choose to do it, then plan carefully and have a companion with you who knows what to do at all times. Other low-moderate risk sporting activities can be undertaken, but having a plan in place if a seizure occurs is always a good idea.
Sports to undertake with caution
Taking part in physical activity and sports is an individual choice and you also need to consider your individual situation. While we recommend being active, it is important to think about your safety and the safety of others.
Think about the:
- Type of sport – is it high or low risk?
- Likelihood of a seizure happening
- Seizure triggers (for example, strenuous activity, overheating)
- Type and severity of your seizures
- Usual timing of your seizures
- Individual approach and attitude.
The below sports are considered “high risk” especially if your seizures aren’t fully controlled.
- Aviation sports
- Diving (platform, springboard)
- Horse racing (competitive)
- Motor sports
- Parachuting, hang gliding (and similar sports)
- Scuba diving
- Ski jumping
- Solitary sailing
- Surﬁng, wind-surﬁng
Discuss any water-based or possible risky sports with your neurologist.
Returning to sport after a having a seizure
How soon can someone return to play after a seizure?
If it’s your first seizure, a thorough neurological assessment is needed. The cause of the seizure needs to be determined before returning to sport. If the seizure was provoked by another condition then treatment of that particular condition will be necessary.
If seizures have an unknown cause, restrictions 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, such as a protective helmet
- If it is possible a seizure may happen, make sure someone (such as the coach) knows you have epilepsy and knows what to do
- Ask the doctor whether certain sports aren’t 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 performance enhancing drugs as they can also alter the effects of medications
Sports and physical activity is generally a good lifestyle choice. It can enhance your quality of life, reduce other or future health issues, and potentially have a positive effect on your seizure frequency.
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