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

Background What is Epilepsy? Epilepsy is a group of neurological disorders characterized by persistent and unpredictable epileptic seizures.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.xArida, RM., Cavalheiro, EA., Silva, AC. & Scorza, FA. (2008). Physical Activity and Epilepsy: Proven and Predicted Benefits. Sports Medicine 38(7), 607-615. doi: 10.2165/00007256-200838070-00006Meyer, 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 These seizures are caused by excessive or abnormal neuronal activity in the brain.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 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.Blume, WT. (2003). Diagnosis and Management of Epilepsy. CMAJ 168(4), 441-448. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143552/ Causes Congenital/genetic disorders Acquired through head trauma or infection Toxic disorders (alcohol and drugs) Prevalence Epilepsy is a very common neurological disorder affecting almost 2% of the world’s population.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 This accounts for approximately 50 million people worldwide. 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. Temporal lobe epilepsy is the most common form of epilepsy accounting for 20% of all diagnoses. Treatments The most common treatment for epilepsy is the use of anti-epileptic drugs (AEDs).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.2010.01.013Ablah, 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.2008.09.019Nakken, KO. (2007). Clinical Research Physical Exercise in Outpatients with Epilepsy. Epilepsia 40(5), 643-651. doi: 10.1111/j.1528-1157.1999.tb05568.x This type of treatment tends to be long term and suppresses seizures. However non-pharmacological treatments or complimentary therapies include surgery, vagal nerve stimulation, ketogenic diet, yoga and electroencephalography.Saxena, VS., Nadkarni, VV. (2011). Nonpharmacological Treatment of Epilepsy. Ann Indian Acad Neurol 14(3), 148-152. doi: 10.4103/0972-2327.85870 Physical Activity People with epilepsy are often discouraged from participating in physical activity by health professionals and family members, in case of exercise induced seizure.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.2001.0271Arida, 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.Arida, RM., Scorza, FA., Terra, VC., Scorza, CA., Almeida, AC. & Cavalheiro, EA. Epilepsy and Behaviour 16(3), 381-387. doi: 10.1016/j.yebeh.2009.08.023Arida, 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.xArida, 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 However, the occurrence of exercise induced seizures are quite rare. This is a major contributor to the lower physical activity levels in people with epilepsy compared to the general population. This puts them at a greater risk of obesity and related co-morbidities. Physical activity appears to reduce the occurrence of seizures and improve other areas of health including cardiovascular health, weight control and bone health. 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. Barriers 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 Type of Physical Activity Hypothesised Effect * Anaerobic * Moderate Intensity Aerobic* Yoga* General Physical Activity. * 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 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. Recommendations It is hard to make generalized recommendations for physical activity as epilepsy encompasses large number of diseases. Recommendations must take into account frequency and type of seizures occurring as well as general medical history. However, most sports are deemed safe for epileptic patient participation, though some may need more supervision eg. water sports. 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. The psychological stress of the type of physical activity should also be considered. Further reading Epilesy and Lifestyle, Epilepsy Australia - http://www.epilepsyaustralia.net/Epilepsy_Information/Epilepsy_and_Lifestyle/Epilepsy_and_Lifestyle.aspx Sports and Activities, Epilepsy Action Australia - http://www.epilepsy.org.au/living_with_epilepsy/lifestyle_issues/sports_and_activities References