Exercise is good for everyone and leads to improved physical and psychological health outcomes, which also benefits people with epilepsy.
Seizures during sports activity are rare, but coaches, parents and possibly team mates should know what to do if a seizure occurs. Most sports activities are acceptable as long as the person with epilepsy avoids overexertion, dehydration, and low blood sugar (hypoglycemia).
Striking a safe balance between the epilepsy, its treatment, and appropriate exercise recommendations can bring people important health benefits.
Exercise and epilepsy
People with epilepsy and their families are often concerned about seizures during exercise which often results in overprotection and needless activity restrictions. So an understanding of how exercise affects both epilepsy and seizures is important.
There are many potential seizure triggers that exist in relation to physical exercise such as fatigue, stress, repeated head injury during contact sports, excessive aerobic exercise, hyperventilation, changes in the metabolism of antiepileptic medication, and electrolyte disturbances. But in general, seizures are rarely triggered by exercise. There also has been no link found between exercise related fatigue and increased seizures. Very occasionally, people report their seizures are triggered by exercise.
Epilepsy may improve with exercise, and in one study more than a third of people reported this. 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. They speculated that this increased mental concentration may reduce seizure frequency.
One study showed in approximately 10% of people, exercise appeared to trigger seizures, but only 2% of these people had genuine exercise induced seizures, and this particularly affected people with focal epilepsy.
Overall fitness and a feeling of well-being have been reported 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.
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.
Medications and exercise
Antiepileptic medications 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, and most likely contributes to low motivation to exercise. 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. Sodium valproate (Epilim) and lamotrigine (Lamictal) may cause weight gain, but a regular exercise program may overcome this effect. Antiepileptic drug selection must consider individual concerns.
Physical training appears to affect blood levels of some medications. Thus, blood antiepileptic medication levels of people who have regular exercise programs should be monitored, especially in the first few months of training or if seizure changes are noted. Additionally, athletes who have epilepsy should avoid anabolic steroids because they may affect epilepsy medication 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 stimulator implanted, 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 think about 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, tumour, 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, 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 anabolic steroids as they can also alter the effects of medications
For more information:
Videos – Dr Dan McLaughlin – Seizures and Sport