# Exercise as it relates to Disease/Exercise and epilepsy
## Background
### What is Epilepsy?

Epilepsy is a neurological condition which affects the nervous system and can be classified as a disruption of the normal electrochemical activity within the brain, which ultimately results in seizures. Although anyone can be subjected to having a one off seizure, it is when an individual has at least two seizures that were not caused by a known medical condition that epilepsy can be diagnosed.

### Prevalence

Epilepsy is considered to be the worlds most common serious brain disorder. Worldwide there are approximately 50 million sufferers, with 85% of those living in developing countries. In Australia, it is estimated that there are over 225,000 people living with epilepsy, while approximately 3-3.5% of Australians will experience some form of epilepsy in their lifetime.

### Seizure Types and Classifications

Seizures can be classified into three major groups:
1) Focal (partial) Seizures: 60% of people who have epilepsy have these types of seizures. Seizure activity starts in one area of the brain and may spread throughout. Types of focal seizures include:
* Focal Seizure: awareness retained
* Focal Dyscognitive Seizure: awareness altered
* Focal seizures evolving to a bilateral convulsive seizure
2) Generalised seizures: abnormal activity in both hemispheres of the brain simultaneously, leading to loss of consciousness at onset of seizure.
* There is also a secondary generalized seizure which is when the epileptic activity started as a focal seizure, but then spreads to both hemispheres of the brain. Consciousness is lost when the seizure spreads to both hemispheres.
3) Unknown Seizures: there is a group of seizures that are not classified as either focal or generalized seizures.

### Causes of Epilepsy

For many epilepsy sufferers, the cause of their condition is unknown. Genetics is though tot play an important role in the development of epilepsy, as it shows that some people are more prone to having seizures than others. Structural abnormalities that occur during brain development, such as infections (meningitis or encephalitis) or lack of oxygen to the brain during birth or after a stroke can also be causes of epilepsy. Brain injuries that result in development in scar tissue is also a predisposing factor for the development of epilepsy.

## Treatments

* Medical Management: medication is the first step of management of epilepsy, and for up to 70% of people this can lead to complete seizure control when coupled with a sensible lifestyle, which allows a full and active lifestyle to be possible.
* Surgery: For certain types of epilepsy, this treatment option can offer a possibility of a seizure free life or a reduction in the amount of seizures.
* Vagus Nerve Stimulation (VNS): a pace-maker device periodically stimulates the left vagus nerve in the neck, which reduces the frequency and intensity of seizures.
* Complementary Therapies: many alternative options used to improve health, combat illness or in hope to prolong life.
It is important to note that these treatments do not 'cure' epilepsy as a cure is still not known, they provide a means of controlling the seizures.

## Exercise and Epilepsy

Stigma surrounding exercise and epilepsy is that it is unsafe for sufferers and that participating in it can actually bring on a seizure. However this is only the case in a small portion (around 10%) of the population and those with partial epilepsy were particularly affected. Exercise is often considered a stress reliever for epilepsy sufferers when undertaken in a safe way. Exercise has the ability to improve cardiovascular health and decrease depression and as a result significantly lower seizure frequency. Participating in exercise also helps improve self- esteem and social integration. Although participation in sports are encouraged for epilepsy sufferers, there are some sports that may not be appropriate to undergo, especially if seizures are not fully controlled. Some of these include boxing, aviation sports, gymnastics, motor sports and full-contact karate. However, most sports, including contact sports like football, have not shown an increase in the chance of seizures, but they do come with an increased chance of head injury so they should be undertaken with care. The key is to find the type of exercise that feels right for 'you'.
Some tips which are important to take into account when considering undertaking exercise are:
* Consult your neurologist about if you are sufficiently stable to participate in regular exercise
* Take all medications as recommended by your physician
* Perform a Pre-exercise screening test
* Pay attention to precipitating factors of your seizures.
* If your a beginner, start small with short workouts of 10–15 minutes and build up to 30 minute workouts, up to 5 days a week.
* A strength training session can be added in twice a week after exercising for a period of time with no seizures.

## Further reading

For further information regarding Epilepsy and Exercise contact your health care professional or call/visit:
* Epilepsy National Helpline Tel. 1300 852 853
* Epilepsy Australia http://www.epilepsyaustralia.net/Epilepsy_Information/Epilepsy_Information.aspx
* Epilepsy Action Australia http://www.epilepsy.org.au/about-epilepsy

## References

* 1 2 3 4 5 6 7 8 9 10 Epilepsy Action Australia (2013)http://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/what-epilepsy
* ↑ Epilepsy.com (2013) https://www.epilepsy.com/101/ep101_epilepsy
* ↑ World Health Organization (2013) http://www.who.int/mental_health/neurology/epilepsy/en/
* ↑ Medical News Today (2009) What is Epilepsy? http://www.medicalnewstoday.com/articles/8947.php
* ↑ Epilepsy Australia (2013)Epilepsy Explained: What Causes Epilepsy. Epilepsy Australia http://www.epilepsyaustralia.net/Epilepsy_Information/Epilepsy_explained/Epilepsy_explained.aspx
* ↑ Ablah, E., et al (2009) Exercise and Epilepsy: a Study of Midwest Epilepsy Patients. Epilepsy and Behaviour, 14, 1, 162-166
* ↑ Roth, D.L et al (1994) Physical Exercise, Stressful Life Experience, and Depression in Adults with Epilepsy. Epilepsia, 35, 1248-1255
* ↑ Epilepsy Society (2013) http://www.epilepsysociety.org.uk/exercise
* 1 2 3 Better Health Channel (2012) http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Epilepsy_and_exercise
* 1 2 3 EmpowerHER (2011) http://www.empowher.com/fitness/content/exercise-and-epilepsy