# 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. These seizures are caused by excessive or abnormal neuronal activity in the brain. 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.

### 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. 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). 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.

## 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. 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

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