ArticleLiterature Review

Physical Activity and Epilepsy

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Abstract

Epilepsy is a common disease found in 2% of the population, affecting people from all ages. Unfortunately, persons with epilepsy have previously been discouraged from participation in physical activity and sports for fear of inducing seizures or increasing seizure frequency. Despite a shift in medical recommendations toward encouraging rather than restricting participation, the stigma remains and persons with epilepsy continue to be less active than the general population. For this purpose, clinical and experimental studies have analysed the effect of physical exercise on epilepsy. Although there are rare cases of exercise-induced seizures, studies have shown that physical activity can decrease seizure frequency, as well as lead to improved cardiovascular and psychological health in people with epilepsy. The majority of physical activities or sports are safe for people with epilepsy to participate in with special attention to adequate seizure control, close monitoring of medications, and preparation of family or trainers. The evidence shows that patients with good seizure control can participate in both contact and non-contact sports without harmfully affecting seizure frequency. This article reviews the risks and benefits of physical activity in people with epilepsy, discusses sports in which persons with epilepsy may participate, and describes the positive effect of physical exercise in experimental models of epilepsy.

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... Although both qualitative and quantitative research has presented the positive impact of sports and exercise for a person with epilepsy [1][2][3]5,6], the prevalence of regular exercise for a person with epilepsy is lower compared to the general public [7], as there are still common barriers (both physical and psychosocial) that prevent many PWE from feeling the benefits of exercise [4,5,8]. The main barriers to sports and exercise reported are fear of the seizure occurring [4,8], fear of seizure-related injuries [9], stigma [5,10], and incorrect advice from medical professionals [4,5,[11][12][13]. As a result, this inactivity has shown to cause social isolation, low self-esteem, weight gain, and depression [5,9,11]. ...
... The main barriers to sports and exercise reported are fear of the seizure occurring [4,8], fear of seizure-related injuries [9], stigma [5,10], and incorrect advice from medical professionals [4,5,[11][12][13]. As a result, this inactivity has shown to cause social isolation, low self-esteem, weight gain, and depression [5,9,11]. ...
... The barriers and adaptations used by PWE to exercise confirm previous literature as well as provided new insights into the methods used to overcome such barriers. Barriers to exercise, e.g., exercise type and intensity, as well as advice in regard to stopping exercise, have previously been shown [1,[4][5][6]11,12,14,19]. However, to the best of our knowledge, overheating with exercise as a seizure trigger is a new addition to current barriers. ...
Article
Exercise has been shown to be a physiological and psychological benefit for people with epilepsy (PWE). However, barriers prevent many PWE from exercising safely and confidently. This research explored current perceived barriers to exercise and adaptation techniques used by PWE in order to maintain physical activity levels. Three focus groups (2–3 participants per group) and three semi-structured interviews were conducted (11 participants total). Constructive grounded theory was used to frame the study and analyse the findings, presenting new insight into the motivation, perceived barriers, and adaptation techniques used to exercise. The main motivator to maintain physical activity levels was the benefit of exercise on physical and mental health. This was shown in an increase in mood, higher social interaction, and perceived improvement in overall physical health as a result of exercise. Current barriers to exercise included a fear of injury, lack of social support, and exercise-induced seizures (e.g., through overheating and/or high exercise intensity level). Adaptation techniques used were self-monitoring through the use of technology, reducing exercise frequency and intensity level, and exercising at certain times of the day. The importance of social support was shown to provide increased confidence and positive encouragement to exercise, contrasting with family and friends worrying for his/her safety and medical professionals requesting termination of some physical activities. These findings provide new insight into current adaptation techniques that are used and developed by PWE to overcome common barriers to exercise. These new additions to the literature can lead to further development of such techniques as well as examine current medical professionals' knowledge of the benefits of exercise for PWE.
... Role of Exercise People with epilepsy are less likely to engage or even intend to engage in physical activities [42][43][44]. In a Norwegian sample, the proportion of people never exercising was significantly greater for an epilepsy cohort than the average population [45]. ...
... The physiological parameter of interest is the modifiable risk factor cardiorespiratory fitness, which is lower in people with epilepsy than age and gender-matched controls [46]. People with epilepsy have often been discouraged from partaking in physical activity due to concerns about inducing or increasing the frequency of seizures [43]. Similarly, interventions designed to increase exercise in people with epilepsy often fail to initially increase exercise or sustain increased exercise [47]. ...
... Another possible mechanism is that people with epilepsy are more likely to be obese as they exercise less [43,45,49,53]. They are also more likely to be obese if treated with VPA [35][36][37], contributing to mitochondrial dysfunction and adiponectin deficiency. ...
Article
Epilepsy, a common neurologic condition, is associated with a greater prevalence of type 2 diabetes mellitus (T2DM). We examined potential drivers for the comorbidity of epilepsy and T2DM in an attempt to elucidate possible biological mechanisms underlying the development of processes in individuals. We searched PubMed and Medline up to December 2019. Our search yielded 3361 articles, of which 82 were included in the scoping review. We reviewed articles focusing on the association of epilepsy and T2DM, drivers, and biological mechanisms. We found that epilepsy is associated with obesity and obesity is associated with T2DM. Treatment with valproate (either sodium or acid) is associated with weight increase and hyperinsulinemia, while topiramate causes weight loss. People with epilepsy are less likely to exercise, which is protective against obesity. Mitochondrial dysfunction and adiponectin deficiency are common to epilepsy and T2DM. One possible mechanism for the comorbidity is mitochondrial dysfunction and adiponectin deficiency, which promotes epilepsy, obesity, and T2DM. Another possible mechanism is that people with epilepsy are more likely to be obese because of the lack of exercise and the effects of some antiseizure medications (ASMs), which makes them susceptible to T2DM because of the development of mitochondrial dysfunction and adiponectin deficiency. A third mechanism is that people with epilepsy have greater mitochondrial dysfunction and lower adiponectin levels than people without epilepsy at baseline, which may exacerbate after treatment with ASMs. Future research involving a combined genetic and molecular pathway approach will likely yield valuable insight regarding the comorbidity of epilepsy and T2DM.
... Unfortunately, individuals with epilepsy have previously been discouraged from participation in physical activity and sport for fear of inducing seizures or increasing the frequency of seizures. Despite a shift in medical recommendations toward encouraging rather than restricting participation, the stigma remains, and individuals with epilepsy continue to be less active than the general population (Arida, Cavalheiro, da Silva, & Scorza, 2008). Research has revealed that despite the growing trend of youth with epilepsy to participate in sports activities, there continues to be a lingering hesitation among parents and children to engage in physical activity (Brna, Gordon, Woolridge, Dooley, & Wood, 2017). ...
... The majority of physical activities or sports are safe for individuals with epilepsy to participate in with special attention to adequate seizure control, close monitoring by educators of medications, and preparation of family or trainers (Willis, Hophing, Mahlberg, & Ronen, 2018). Evidence indicates that children and individuals with good seizure control can participate in both contact and non-contact sports without harmfully affecting seizure frequency (Arida et al., 2008), although most physical education programs should be cautious when introducing activities with high levels of physical contact, within reason, for all participants. Additionally, parents of children with epilepsy have also indicated personal emotional benefits as a result of their child engaging in quality physical education and/or physical activity programs (Willis et al., 2018). ...
Article
Full-text available
Pennington, C. G. & Webb, L. M.* (2020). Inclusive Physical Activity and Physical Education for Students with Epilepsy. Journal of Physical Education, Recreation & Dance. 91(2), 52-53. DOI:10.1080/07303084.2020.1696135. Chances are if you are an educator for any more than a few years you are likely to come into contact with numerous students under your care who have a variety of physical impairments. These impairments, on the surface, may appear to be significant deterrents to participation in physical education or physical activity. However, with some modifications and special attention to these students, and specific activity selection, physical education can be an extremely inclusive environment for students with physical disabilities and limitations (Webb & Pennington, 2019). One such physical impairment which, with attention and modification, does not need to limit students’ physical activity or physical education participation is epilepsy.
... Physical activity (PA) is recognized to be beneficial for multiple health outcomes and quality of life (QoL) in individuals with epilepsy [1][2][3]. Logically, PA should also be beneficial for children with epilepsy (CWE); however, this population tends to hesitate participating in PA because of a host of factors including fear of injury, parental overprotection, and lack of knowledge regarding the benefits and risks associated with PA [4][5][6]. For this reason, CWE tend to achieve less than the recommended national guidelines of 60 min of moderate-to-vigorous PA per day [7][8][9], which may contribute to various, often long-term, comorbidities and poor functioning [1,10,11]. ...
... Logically, PA should also be beneficial for children with epilepsy (CWE); however, this population tends to hesitate participating in PA because of a host of factors including fear of injury, parental overprotection, and lack of knowledge regarding the benefits and risks associated with PA [4][5][6]. For this reason, CWE tend to achieve less than the recommended national guidelines of 60 min of moderate-to-vigorous PA per day [7][8][9], which may contribute to various, often long-term, comorbidities and poor functioning [1,10,11]. ...
Article
Purpose: This study examined whether increasing physical activity (PA) through 6 months of behavioral counseling positively influenced depressive symptoms and quality of life (QoL) over 12 months among children with epilepsy (CWE). Methods: A longitudinal multisite randomized controlled trial (RCT) was conducted with 8-14-year-old children with active epilepsy. Participants wore a pedometer to track daily PA and completed 3 measures at 4 time points to examine depressive symptoms and QoL. Stratified by site and activity level, participants were randomized to an intervention or control group. The 6-month intervention included 11 behavioral counseling sessions targeting self-regulation of PA. To assess the associations among PA, depression scores, and QoL, primary analysis involved mixed-effects models. Results: We recruited 122 CWE, of whom 115 were randomized (Mage = 11 ± 2; 50% female) and included in the analysis. The intervention did not increase PA in the treatment compared with the control group. No differences were found between groups over time during the subsequent 6 months, where PA decreased among all participants. Results did not show differences between the groups and over time for measures of depressive symptoms and QoL. Significance: The intervention did not improve or sustain PA levels over 12 months. Both groups demonstrated declines in PA over one year, but there were no changes in depression scores or QoL. As most participants were already nearly reaching the Canadian average of step counts of children their age, with a baseline daily step count of over 9000, there may be a challenge for further increasing PA over a longer period.
... Unfortunately, individuals with epilepsy have previously been discouraged from participation in physical activity and sport for fear of inducing seizures or increasing the frequency of seizures. Despite a shift in medical recommendations toward encouraging rather than restricting participation, the stigma remains and individuals with epilepsy continue to be less active than the general population (Arida, Cavalheiro, da Silva, & Scorza, 2008). Research reveals that despite the growing trend of youth with epilepsy to participate in sports activities, there continues to be a lingering hesitation among parents and children to engage in physical activity (Brna, Gordon, Woolridge, Dooley, & Wood, 2017). ...
... The majority of physical activities or sports are safe for individuals with epilepsy to participate in with special attention to adequate seizure control, close monitoring by educators of medications, and preparation of family or trainers (Willis, Hophing, Mahlberg, & Ronen, 2018). Evidence indicates that children and individuals with good seizure control can participate in both contact and non-contact sports without harmfully affecting seizure frequency (Arida et al., 2008), although most physical education programs should be cautious when introducing activities with high levels of physical contact, within reason, for all participants. Additionally, parents of children with epilepsy have also indicated personal emotional benefits as a result of their child engaging in quality physical education and/or physical activity programs (Willis et al., 2018). ...
Article
Full-text available
Coaches and physical educators are likely to come into contact with numerous students under their care who have a variety of physical impairments. These impairments, on the surface, may appear to be significant deterrents to participation in physical education, sports, and/or physical activity. However, with some modifications and special attention to these students and specific activity selection, physical education and sporting experiences can be an extremely inclusive environment for students with physical disabilities and limitations. Therefore, the purpose of this article is to focus specifically on youth and pediatric physical disabilities and cognitive impairments, and the manifestations of particular symptoms as they relate to physical activity and movement opportunities in physical education. General backgrounds of the conditions are detailed, as well as recommendations to modifications of physical activity, and general safety/First Aid responses for individuals with these conditions. It is recommended that physical activities and physical education for each student be individualized depending upon one's particular set of conditions. For complete and fulfilling exercise and sport experiences, both static and dynamic exercises are encouraged, although it is important to consider the level of intensity of the exercise or activity. Furthermore, open circuit activities, like traditional team sports such as basketball or soccer, inherently possess more risks and concerns to safety than closed circuit activities.
... However, despite the physical and mental benefits of physical activity, exercise is still not a regular occurrence for people with epilepsy [3]. The main reasons reported for inactivity are the fear of the seizure occurring [4,5], fear of seizure-related injuries [6], and being inadequately informed about the possibilities of playing sports [7]. As a potential result of this inactivity, at least in part, social isolation, low self-esteem, weight gain, and depression are commonly found among people with epilepsy [7,8]. ...
Article
Research has presented the benefits of and barriers to exercise for people with epilepsy through quantitative means. However, individual experiences through qualitative investigations have been absent. This research will present the narratives of people with epilepsy exercising over time and, as a result, develop further understanding of the psychosocial impact of exercising with epilepsy. Four interviews were conducted over the course of one year (one every three to four months) with four participants (aged 23-38years) who varied in seizure type and control (16 interviews in total). A narrative analysis was used to analyze their exercise experiences. Results showed that exercise creates a positive effect on psychological and physical well-being. However, prevention from exercise as a result of medical advice or recurrent seizures can create negative effects such as social isolation, anxiety, lack of confidence, frustration, and anger. Adaptations of decreasing exercise intensity level and partaking in different physical activities are techniques used to lessen the negative impact and maintain an exercise routine. Time was shown to be an important factor in this adaptation as well as portrayed the cyclical responses of negative and positive emotions in regard to their exercise life. These findings provide valuable insight into the psychosocial benefits of and barriers to exercising with epilepsy and draw attention to the individual differences in how a person with epilepsy copes with uncontrolled seizures and their impact on his/her exercise routine. This knowledge can lead to future research in exploring how a person with epilepsy can overcome these barriers to exercise and encourage more people with epilepsy to enjoy the benefits of exercise.
... First, as the medical community have not reached a consensus about the benefits and promotion of exercise, many PWE are inadequately informed about the possibilities of exercising (Sirven, 2009). Second, PWE have reported a fear of seizures and seizure-related injuries (Arida, Cavalheiro, da Silva, & Scorza, 2008). Third, looking at the effect social support has upon a PWE's decision to exercise, Ablah et al. (2009) found that 68% of 412 surveyed epilepsy patients were actively discouraged by family members or another influence. ...
Article
Objectives: There is an abundance of quantitative and medical research promoting the benefits of exercise for people with epilepsy. However, the psychosocial barriers and benefits of exercising for the sportsperson/people with epilepsy (SWE) are absent. This research aims to present the narratives of SWE over time and as a result, develop further understanding of the psychosocial impact of exercising with epilepsy. Method: A holistic-content and structural narrative analysis were used to explore the exercise experiences of three SWE over the course of one year. A creative non-fictional technique was used to present first person narratives, therefore providing the SWE's voice for the reader. Results: Narratives of 'vicious cycle' and 'roller coaster' presented complex and multi-thematic storied forms, with time and the hidden nature of epilepsy having a strong impact on narrative formation. Vicious cycle presented the cycle of desiring to exercise, but prevented from exercising because of uncontrolled seizures. This resulted in frustration and feelings of a lack of control, which subsequently increased the desire to exercise and created a cycle with no clear end. Roller coaster presented the constant psychosocial and physical undulations that epilepsy can create for a SWE over time. Conclusion: These narratives reveal that exercising with epilepsy has a constant and on-going positive and negative impact on the life of SWE. However, these narratives also show that it may be through the process of acceptance of their body's limitations that a healthier mental and physical state may result for the SWE.
... Physical exercise, primarily aerobic exercise, offers many health benefits to the individual, including the prevention and treatment of numerous chronic conditions such as metabolic, cardiovascular, and pulmonary diseases, musculoskeletal and autoimmune disorders, and even cancer (Pedersen and Saltin, 2015). In the brain, physical exercise interventions can improve outcomes in both acute and chronic neurodegenerative, neurological and psychiatric conditions including stroke, depression, epilepsy, Alzheimer's and Parkinson's Disease (Arida et al., 2008;Ahlskog, 2011;Saunders et al., 2014;Duzel et al., 2016). From studies in both animals and humans, physical exercise has been linked to direct changes in the brain in terms of neuronal plasticity and improved cognition throughout life, with effects on trophic signaling, neuronal function and structure of the brain (Hillman et al., 2008 Abbreviations: ANOVA, analysis of variance; BDNF, brain-derived neurotrophic factor; BSA, bovine serum albumin; DG, dentate gyrus; FNDC5, fibronectin type III domain-containing protein 5; GCL, granule cell layer; IR, ionizing radiation; MCK-PGC-1a, transgenic mice overexpressing PGC-1a under muscle creatinine kinase promoter; PGC-1a, peroxisome proliferator-activated receptor gamma coactivator 1-alpha; ROS, radical oxygen species; RT, room temperature; SGZ, subgranular zone; SVZ, subventricular zone. ...
Article
Physical exercise can improve morphological outcomes after ischemic stroke and ameliorate irradiation-induced reduction of hippocampal neurogenesis in rodents, but the mechanisms underlying these effects remain largely unknown. The transcription factor PGC-1α is considered to be one of the central factors responsible for exercise-induced benefits in skeletal muscle, including the release of neurotrophic factors into the circulation. In order to test if PGC-1α overexpression in skeletal muscle could simulate the exercise-induced effects on recovery after cranial irradiation and stroke, we used male adult transgenic mice overexpressing murine PGC-1α under the control of muscle creatinine kinase promoter and subjected them to either whole brain irradiation at a dose of 4 Gy or photothrombotic stroke to the sensory motor cortex. Muscular PGC-1α overexpression did not ameliorate irradiation-induced reduction of newborn BrdU-labeled cells in the dentate gyrus, immature neurons, or newborn mature neurons. In the stroke model, muscular overexpression of PGC-1α resulted in an increased infarct size without any changes in microglia activation or reactive astrocytosis. No difference could be detected in the number of migrating neural progenitor cells from the subventricular zone to the lesioned neocortex or in vascular density of the contralateral neocortex in comparison to wildtype animals. We conclude that forced muscular overexpression of PGC-1α does not have a beneficial effect on hippocampal neurogenesis after irradiation, but rather a detrimental effect on the infarct volume after stroke in mice. This suggests that artificial muscle activation through the PGC-1α pathway is not sufficient to mimic exercise-induced recovery after cranial irradiation and stroke.
... The impact of physical exercise on seizure frequency and severity in patients with epilepsy remains controversial, although recent studies have indicated that regular physical exercise may decrease seizure frequency, thus improving physiological function as well as psychological characteristics neuropsychological functions in individuals with epilepsy [4,6]. A previous review also highlighted the positive effect of physical exercise on epilepsy in both humans and animals [7]. The latest consensus paper by the International League Against Epilepsy (ILAE) Task Force on Sports and Epilepsy cautiously (depending upon the patient's personal willingness and overall health) suggested that patients with epilepsy should not be prohibited from engaging in athletic activities or competitive sports at any age [8]. ...
Article
Objective: The objective of this study was to elucidate alteration in functional connectivity (FC) in patients with benign epilepsy with centrotemporal spikes (BECTS) as induced by physical exercise therapy and their correlation to the neuropsychological (NP) functions. Methods: We analyzed 115 artifact- and spike-free 2-second epochs extracted from resting state EEG recordings before and after 5weeks of physical exercise in eight patients with BECTS. The exact Low Resolution Electromagnetic Tomography (eLORETA) was used for source reconstruction. We evaluated the cortical current source density (CSD) power across five different frequency bands (delta, theta, alpha, beta, and gamma). Altered FC between 34 regions of interests (ROIs) was then examined using lagged phase synchronization (LPS) method. We further investigated the correlation between the altered FC measures and the changes in NP test scores. Results: We observed changes in CSD power following the exercise for all frequency bands and statistically significant increases in the right temporal region for the alpha band. There were a number of altered FC between the cortical ROIs in all frequency bands of interest. Furthermore, significant correlations were observed between FC measures and NP test scores at theta and alpha bands. Conclusion: The increased localization power at alpha band may be an indication of the positive impact of exercise in patients with BECTS. Frequency band-specific alterations in FC among cortical regions were associated with the modulation of cognitive and NP functions. The significant correlation between FC and NP tests suggests that physical exercise may mitigate the severity of BECTS, thereby enhancing NP function.
... Previous literature has extensively reported the use of nonpharmacological therapies, including complementary and alternative medicine for the treatment of epileptic seizures [12]. Arida and co-workers [13] reported that regular physical exercise generates psychological and physiological benefits for people with epilepsy. Moreover, individuals with epilepsy involved in exercise programs exhibit an improved mental state, become more sociable, and improve their psychosocial functioning and quality of life [14,15]. ...
Article
Background: Physiotherapists play a key role in the rehabilitation of children with epileptic seizures. Regular physical exercise generates psychological and physiological benefits for people with epilepsy. Design: This study was a cross-sectional design. Purpose: The purpose of this study was to evaluate the knowledge and current practices of physiotherapists on the physical activity and exercise in the rehabilitation of children with epileptic seizures in Nigeria. Methods: Physiotherapists with minimum bachelor's degrees were invited to participate in the study using an electronic questionnaire. The subjects (N = 117) answered a questionnaire comprising 33 simple closed-ended questions with three domains: personal information, knowledge, and current practices. Results: Out of the 117 physiotherapists, 77.7% (n = 91) had postgraduate degrees, 16.2% (n = 19) had bachelor's degree in physiotherapy, and only 5.9% (n = 7) had Doctor of Physical Therapy (DPT). The results also indicated that 79.5% (n = 93) of physiotherapists had sufficient knowledge about epilepsy, and 86.3% (n = 101) of physiotherapists were using current skills/physical activity to rehabilitate children with epileptic seizures. Conclusions: It was concluded that physiotherapists had sufficient knowledge about epilepsy and were using current skills/physical activity in the rehabilitation of children with epileptic seizures.
Article
Epilepsy is one of the commonest neurologic diseases and has always been associated with stigma. In the interest of safety, the activities of persons with epilepsy (PWE) are often restricted. In keeping with this, physical exercise has often been discouraged. The precise nature of a person's seizures (or whether seizures were provoked or unprovoked) may not have been considered. Although there has been a change in attitudes over the last few decades, the exact role of exercise in inducing seizures or aggravating epilepsy still remains a matter of discussion among experts on the field. Based mainly on retrospective, but also on prospective, population and animal-based research, the hypothesis that physical exercise is prejudicial has been slowly replaced by the realization that physical exercise might actually be beneficial for PWE. The benefits are related to improvement of physical and mental health parameters and social integration and reduction in markers of stress, epileptiform activity and the number of seizures. Nowadays, the general consensus is that there should be no restrictions to the practice of physical exercise in people with controlled epilepsy, except for scuba diving, skydiving and other sports at heights. Whilst broader restrictions apply for patients with uncontrolled epilepsy, individual risk assessments taking in to account the seizure types, frequency, patterns or triggers may allow PWE to enjoy a wide range of physical activities.
Article
Studies in adult animals have demonstrated a beneficial effect of physical exercise on epileptic insults. Although the effects of physical exercise on the mature nervous system are well documented, its influence on the developing nervous system subjected to injuries in childhood has been little explored. The purpose of our study was to investigate whether a physical exercise program applied during brain development could influence the hippocampal plasticity of rats submitted to status epilepticus (SE) induced by pilocarpine model at two different ages of the postnatal period. Male Wistar rats aged 18 (P18) and 28 (P28) days were randomly divided into four groups: Control (CTRL), Exercise (EX), SE (SE) and SE Exercise (SE/EX) (n = 17 per group). After the aerobic exercise program, histological and behavioral (water maze) analyses were performed. Our results showed that only animals subjected to pilocarpine-induced SE at P28 presented spontaneous seizures during the observational period. A significant reduction in seizure frequency was observed in the SE/EX group compared to the SE group. In adulthood, animals submitted to early-life SE displayed impairment in long-term memory in the water maze task, while the exercise program reversed this deficit. Reduced mossy fiber sprouting in the dentate gyrus was noted in animals that presented spontaneous seizures (SE/EX vs SE). Exercise increased cell proliferation (Ki-67 staining) and anti-apoptotic response (bcl-2 staining) and reduced pro-apoptotic response (Bax staining) in animals of both ages of SE induction (P18/28). Exercise also modified the brain-derived neurotrophic factor (BDNF) levels in EX and SE/EX animals. Our findings indicate that in animals subjected to SE in the postnatal period a physical exercise program brings about beneficial effects on seizure frequency and hippocampal plasticity in later stages of life.
Article
Exercise can improve cognitive function and has been linked to the increased expression of brain-derived neurotrophic factor (BDNF). However, the underlying molecular mechanisms driving the elevation of this neurotrophin remain unknown. Here we show that FNDC5, a previously identified muscle protein that is induced in exercise and is cleaved and secreted as irisin, is also elevated by endurance exercise in the hippocampus of mice. Neuronal Fndc5 gene expression is regulated by PGC-1α, and Pgc1a(-/-) mice show reduced Fndc5 expression in the brain. Forced expression of FNDC5 in primary cortical neurons increases Bdnf expression, whereas RNAi-mediated knockdown of FNDC5 reduces Bdnf. Importantly, peripheral delivery of FNDC5 to the liver via adenoviral vectors, resulting in elevated blood irisin, induces expression of Bdnf and other neuroprotective genes in the hippocampus. Taken together, our findings link endurance exercise and the important metabolic mediators, PGC-1α and FNDC5, with BDNF expression in the brain.
Article
Epilepsy is a chronic disease characterized by recurrent, mostly unprovoked seizures with impaired motor, autonomic, mental or mental functions that occur as a result of excessive neuronal discharges in the gray matter of the cerebral cortex. The problem of the activity of medical rehabilitation for epilepsy in the professional community remains debatable, despite the obviousness of the arguments and judgments presented. Purpose of the study: Development of an effective and safe complex for the rehabilitation of young children with epilepsy, accompanied by impaired movement function. Material and methods: The study included 123 young children (from 9 to 24 months) with epilepsy accompanied by impaired motor function. By the method of simple randomization, all patients were divided into 4 groups: 3 main groups and a comparison group. All children of the study groups, except for the comparison group, received medical rehabilitation: in the 1st group - classical massage with the exception of the cervical-collar zone; in the 2nd group - kinesitherapy according to the method of V. Voigt; in the 3rd group - a complex effect, including classical massage with the exclusion of the neck-collar zone and kinesitherapy according to the method of V. Voigt. Children of the comparison group received basic therapy. The effectiveness of medical rehabilitation was analyzed using the Gross motor function classification system (GMFCS) and the Griffiths intellectual development scale. Results: Differences in GMFCS scores before and after medical rehabilitation were statistically significant in group 3. In patients with impaired movement function and suffering from epilepsy, the positive dynamics during complex rehabilitation was more pronounced than when using one isolated technique. Conclusion: Complexity in planning and prescribing a course of rehabilitation determines the greatest efficiency in reducing the deficit of physical activity. With an increase in the index of epileptiform activity according to electroencephalography data without any clinical manifestations, it is not required to cancel rehabilitation measures, it is necessary to strengthen control over the patient.
Article
Although physical activity can have substantial mental and physical health benefits, people with cerebral palsy usually lead sedentary lives. To understand, at an individual level, this inactivity, we interviewed a 29-year-old minimally active woman with cerebral palsy (Alana) about the meanings and experiences of physical activity throughout her life. Using a case-study approach, we found that Alana had adverse childhood experiences with physical activity, including: having to perform difficult, and sometimes painful, physiotherapy; wearing callipers to assist her walking; demonstrating limited competence at physical activity; being excluded from physical education and other organised physical activity at school; and feeling socially isolated from her classmates. These experiences seemed to contribute to feelings of difference/inferiority and the subsequent avoidance of physical activity, which, in turn, might have contributed to premature functional decline. Physical activity levels in people with cerebral palsy might be increased through focusing on enhancing childhood experiences.
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Objective: To investigate the correlation between cardiorespiratory fitness and mood state in individuals with temporal lobe epilepsy (TLE). Method: Individuals with TLE (n = 20) and healthy control subjects (C, n = 20) were evaluated. Self-rating questionnaires were used to assess mood (POMS) and habitual physical activity (BAECKE). Cardiorespiratory fitness was evaluated by a maximal incremental test. Results: People with TLE presented lower cardiorespiratory fitness; higher levels of mood disorders; and lower levels of vigor when compared to control health subjects. A significant negative correlation was observed between the levels of tension-anxiety and maximal aerobic power. Conclusion: Low levels of cardiorespiratory fitness may modify the health status of individuals with TLE and it may be considered a risk factor for the development of mood disorders.
Article
The impact of exercise on mental health, on cognition, brain function and brain structure as well as the possible underlying molecular systems important for maintaining neural function and plasticity has been extensively examined. Moreover, numerous studies have reinforced t the important and beneficial role of exercise for those with neurological disorders. This article reviews general aspects of physical exercise against neurodegenerative diseases and the relevant contributions of physical exercise programs as complementary therapy for epilepsy. We first give an overview of the plasticity induced by exercise in the damaged brain, the impact of exercise in reducing brain injury as well as in delaying onset of and decline in several neurodegenerative diseases. We address the relationship between epilepsy and exercise and report the neuroprotective and antiepileptogenic effects of exercise on epilepsy based on experimental and clinical studies. Overall, we conclude that physical or sport activities represent an exciting intervention that should be integrated with conventional therapy for the improvement of brain function and resistance to neurodegenerative diseases as well as a complementary non-pharmacological treatment of epilepsy.
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Primary objective: To better characterize, describe and highlight issues that individuals with TBI and active LPTS may face in their daily lives. Design: Prospective multi-centre mixed method qualitative and quantitative interview. Participants: Twenty-five individuals, 5-13 years post-injury, who had reported having LPTS and TBI. Measures: Disability Rating Scale (DRS); Supervision Rating Scale (SRS); Glasgow Outcome Scale-Extended (GOS-E); Perceived Stress Scale (PSS); Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF) sub-scales: Physical Independence, Cognitive Independence, Mobility, Occupation, Social Integration; and Craig Hospital Inventory of Environmental Factors (CHIEF); and qualitative interview questions pertaining to management of the seizure disorder and its effect on the individual's health, function, community integration and participation. Results: Data are presented regarding seizure activity and management; return to driving post-seizure; coping and participation; and standardized outcome measures. Conclusions: Individuals with TBI and LPTS are at a double-barrelled disadvantage regarding ongoing physical, cognitive, psychosocial and reintegration issues following brain injury and epilepsy. Clearer clinical guidelines and treatment strategies need to be developed to help ameliorate these ongoing issues. Additional research is needed to identify what the rehabilitation community can do to continue to facilitate people living safely and independently.
Article
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The beneficial effects of physical exercise on epilepsy, such as a decreased seizure frequency, have been observed following aerobic exercise programs in both clinical and experimental studies. However, it is not well clarified whether other types of exercise, including strength exercise, can provide similar benefits for epilepsy. Forty four animals with epilepsy were continuously monitored 24h a day for 60days and divided into two periods of 30days. The first period was used to determine the number of seizures before beginning the physical exercise program, and the second period was utilized to determine the number of seizures during the strength training. The mean frequency of seizures in the control and SHAM groups increased significantly from period 1 to period 2. Although the frequency of seizures did not change significantly between the two periods of 30days of observation in the strength exercise group, a significant reduction in the seizure frequency was observed compared with the control and SHAM groups in period 2. Our study demonstrated that a strength exercise program exerted a significant influence on the seizure frequency in animals with epilepsy and strengthens the observed beneficial effect of exercise on epilepsy that has been demonstrated in animal studies. The finding of this nonclinical study can open a new window to verify the beneficial contribution of strength exercise in epilepsy. Further experimental and clinical investigations are necessary to explore the extent to which strength exercise interferes with the epileptic condition.
Article
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Complementary therapies for preventing or treating epilepsy have been extensively used. This review focuses on the positive effects of physical exercise programs observed in clinical studies and experimental models of epilepsy and their significance as a complementary therapy for epilepsy. Information about the antiepileptogenic and neuroprotective effects of exercise is highlighted. Considering that exercise can exert beneficial actions such as reduction of seizure susceptibility, reduction of anxiety and depression, and consequently, improvement of quality of life of individuals with epilepsy, exercise can be a potential candidate as non-pharmacological treatment of epilepsy. This article is part of a Special Issue entitled Translational Epilepsy Research.
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Over the past decade cardiovascular (CV) fitness training has begun to be incorporated as a standard component of stroke rehabilitation. With any change in practice, clinicians are interested in the best available evidence to guide safe and effective application of the novel intervention. This evidence-based article uses a real-life case to address issues commonly encountered in prescribing CV training for patients in the early poststroke period.
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Individuals with seizure disorders have long been restricted from participation in certain sporting activities. Those with seizure disorders are more likely than their peers to have a sedentary lifestyle and to develop obesity. Regular participation in physical activity can improve both physical and psychosocial outcomes for persons with seizure disorders. Seizure activity often is reduced among those patients who regularly engage in aerobic activity. Recent literature indicates that the diagnosis of seizure disorders remains highly stigmatizing in the adolescent population. Persons with seizure disorders may be more accepted by peer groups if they are allowed to participate in sports and recreational activities. Persons with seizure disorders are encouraged to participate in regular aerobic activities. They may participate in team sports and contact or collision activities provided that they utilize appropriate protective equipment. There seems to be no increased risk of injury or increasing seizure activity as the result of such participation. Persons with seizure disorders still are discouraged from participating in scuba diving and skydiving. The benefits of participation in regular sporting activity far outweigh any risk to the athlete with a seizure disorder who chooses to participate in sports.
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This article provides a practical clinical approach for the role of exercise in the treatment and management of neurologic disorders. A number of clinical studies have reported positive benefits from exercise in various neurologic disease states, suggesting that this mode of intervention should be considered as another option in clinical management. Significant evidence-based data exists confirming the positive effects of exercise in otherwise healthy populations. Good evidence also exists that physical activity may benefit people with long-term neurologic conditions. Despite this evidence, exercise is often neglected in patients with normal aging or neurologic disease progression. Neurologists should counsel patients on this therapeutic adjunct and provide specific recommendations when possible.
Article
Introduction: The concentration and action of ascorbic acid in the central nervous system as a vitamin and also a neuromodulator have exercise-induced fluctuations. The present study was conducted to evaluate the effects of anaerobic exercise alone and associated with the consumption of ascorbic acid as a non pharmacological treatment for reducing seizures and increasing seizure thresholds. Methods: In this experimental study, 28 adult male Wistar rats (200-250gr) were divided into four groups including control (PTZ), anaerobic exercise, ascorbic acid and anaerobic exercise plus ascorbic acid. After performing exercise according to the designed protocol, PTZ was used for inducing seizures (80mg/kg, IP) and seizure latency of different stages was analyzed for each group. Results: In anaerobic exercise plus ascorbic acid group, the latency of the onset of seizure in all stages showed a significant increase in comparison with the control (p<0.001). The data showed that stages 2, 3,4 and 5 latency significantly increased in anaerobic exercise plus ascorbic acid group in comparison with the animals treated with ascorbic acid (p<0.05). Seizure related mortality was significantly decreased in ascorbic acid and also anaerobic exercise plus ascorbic acid groups (0%) compared to the control group (57%, p<0.05). Conclusion: In conclusion, these data suggest that the exercise as well as ascorbic acid and also combination of them have a preventive role in PTZ-induced seizure.
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Background: The present retrospective study was intended to investigate whether working out and other low-speed sports can provoke cardiovascular, neurological, or traumatic damage. Material and methods: Patient data from 2007 to 2013 was collected and saved at the university department of emergency medicine in an electronic patient record database. Results: Of the 138 patients included in this study, 83.3% (n = 115) were male and 16.7% female (n = 23). Most admissions were due to musculoskeletal accidents (n = 77; 55.8%), followed by neurological incidents (n = 23; 16.7%), cardiovascular incidents (n = 19; 13.8%), soft tissue injuries (n = 3; 2.2%), and others (n = 16; 11.6%). The mean age of the allover injured people was 36.7 years. The majority of the patients (n = 113; 81.9%) were treated as outpatients; 24 (17.4%) were inpatients. Discussion. In Switzerland, this is the first study that describes emergency department admissions after workout and examines trauma and neurological and cardiovascular incidents. As specific injuries, such as brain haemorrhages, STEMIs, and epileptic seizures, were relatively frequent, it was hypothesised that workout with its physiological changes may be an actual trigger for these injuries, at least for a specific population. Conclusion: Strenuous physical activity may trigger the risk of cardiovascular, neurological, or trauma events.
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Exercise can improve cognitive function and the outcome of neurodegenerative diseases like Alzheimer’s disease. This effect has been linked to the increased expression of brain-derived neurotrophic factor (BDNF). However, the underlying molecular mechanisms driving the elevation of this neurotrophin remain unknown. Recently, we have reported a PGC-1α-FNDC5/irisin pathway that is activated by exercise in the hippocampus in mice and induces a neuroprotective gene program, including Bdnf. This review will focus on FNDC5 and its secreted form “irisin,” a newly discovered myokine, its role in the nervous system and its therapeutic potential. In addition, we will briefly discuss the role of other exercise-induced myokines in positive brain effects.
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Objective Resources for management of epilepsy in Africa are extremely limited reinforcing the need to develop innovative strategies for optimising care. Studies have shown that the prevalence of epilepsy in low- and middle-income countries is substantially greater than in more resourced countries. The objective of this report was to demonstrate that mobile Health (mHealth) technologies have the potential to improve the management of epilepsy in Africa. Methods The feasibility of technology-based home monitoring was investigated in an observational study of 40 children with refractory epilepsy or epilepsy associated with intellectual disability and/or behaviour difficulties in South Africa. Technology-based home monitoring was implemented for six months. Physical activity, sleep and heart rate were continuously monitored with a wearable device. Caregivers completed regular mobile Patient Reported Outcomes (mPROs) and reported seizures and ad-hoc events using a dedicated app. Feasibility was assessed and descriptively measured for recruitment, retention, and engagement of the participants. Results The mHealth technology was able to capture important information that gives an impression of the overall experience of the children and their caregivers. Thirty-seven participants (94.9%) reported at least one clinical event. Seventy-nine percent of caregivers reported seizure events in their children, which were the primary event anticipated. Median engagement with the wearable device and monthly mPROs was 30.8% and 57.1% respectively. However, most participants (87%) had to be given smartphones for them to have Bluetooth capabilities and access to the study app. Tolerability to the device was impacted by the difficult living circumstances of caregivers that induced fear of loss or theft. Significance The study showed how the use of remote patient monitoring in the form of mHealth can benefit epilepsy patients, despite highly variable engagement with the technology. The combination of mPROs and wearable devices generated informative datasets that will allow clinicians but also the children and their caregivers to better understand and manage the disease.
Article
Objective: Adults aged 50 years and older with epilepsy face an increased risk of fracture associated both with age and with the use of antiepileptic drugs. Lifestyle behaviors, such as physical activity and calcium and vitamin D intake, have been found to be beneficial to bone health. The aim of this study is to investigate these osteoprotective behaviors in people aged 50 years and older with and without epilepsy. Methods: In 2010, the Canadian Community Health Survey (CCHS), a cross-sectional survey that collects health-related data nationwide, included a subset of questions related to epilepsy along with the standard items on physical activity, nutrition, and sun exposure. Data on osteoprotective behaviors were extracted and analyzed for adults aged 50 years and older. Results: There were no significant findings related to calcium and vitamin D intake as measured by food choices and sun exposure survey items. People with epilepsy participated in physical activity significantly less often and for significantly shorter duration than people without epilepsy. Significantly fewer people with epilepsy reported intending to increase exercise in the next 12 months as compared to those without epilepsy. Significance: Although adults aged 50 years and older with epilepsy face an increased risk of fracture as compared to those without epilepsy, they do not engage in a higher level of osteoprotective behaviors. In fact, adults with epilepsy are less physically active and report less intention to exercise than adults without epilepsy.
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Irisin, a skeletal muscle-secreted myokine, produced in response to physical exercise, has protective functions in both the central and the peripheral nervous systems, including the regulation of brain-derived neurotrophic factors. In particular, irisin is capable of protecting hippocampus. Since this area is the region of the brain that is most susceptible to Alzheimer's disease (AD), such beneficial effect may inhibit or delay the emergence of neurodegenerative diseases, including AD. Also, the factors engaged in irisin formation appear to suppress Aβ aggregation, which is the pathological hallmark of AD. This review is based on the hypothesis that irisin produced by physical exercise helps to control AD progression. Herein, we describe the physiology of irisin and its potential role in delaying or preventing AD progression in human.
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Purpose To outline the experiential nature of hidden mental illnesses (or “invisible disabilities”) in sport and physical cultures. A sociological account is given of how people living with a hidden mental illness or disorder manage their identities in physical culture. Approach The chapter begins by addressing the role of social stigma as a barrier to sport and exercise participation for young people living with hidden mental illnesses. From there, and venturing beyond typical sociological tropes about social stigma, the chapter presents ethnographic findings from a study of people living with epilepsy and their tactical uses of a range of physical cultures to craft their selves in innovative ways. Findings People living with so-called simple or nonmajor “hidden/invisible” disabilities are often overlooked as a differential needs population with sport and health zones. The people in this study identify how the desire to be mobile, self-expressive, and authentic through the physical activity pursuits is important yet unavailable to them in a wide range of sport, leisure, and health fields because of the ways in which these places privilege particular types of brain and bodies. Through their own self-styled physical cultural involvements, however, these people challenge the dominance of sport-based model of health promotion in broader culture and disrupt dominant ideological frames that privilege the normative, rational, calculating, and predictable brain in athletic zones. Research Implications The importance of identifying persons who may not participate in sport and physical culture due to perceived and felt stigma is highlighted. In addition, developing creative strategies and programs for these populations is underscored.
Article
People with epilepsy (PWE) are less physically active compared with the general population. Explanations include prejudice, overprotection, unawareness, stigma, fear of seizure induction and lack of knowledge of health professionals. At present, there is no consensus on the role of exercise in epilepsy. This paper reviews the current evidence surrounding the risks and benefits associated with physical activity (PA) in this group of patients. In the last decade, several publications indicate significant benefits in physiological and psychological health parameters, including mood and cognition, physical conditioning, social interaction, quality of life, as well as potential prevention of seizure presentation. Moreover, experimental studies suggest that PA provides mechanisms of neuronal protection, related to biochemical and structural changes including release of β-endorphins and steroids, which may exert an inhibitory effect on the occurrence of abnormal electrical activity. Epileptic discharges can decrease or disappear during exercise, which may translate into reduced seizure recurrence. In some patients, exercise may precipitate seizures. Available evidence suggests that PA should be encouraged in PWE in order to promote wellbeing and quality of life. There is a need for prospective randomized controlled studies that provide stronger clinical evidence before definitive recommendations can be made.
Article
Objectives: In this study, we aim to reveal the alterations (due to seizure) in the serum and brain levels of nesfatin-1, ghrelin and irisin after acute or chronic pentylenetetrazole administrations in rats using sodium valproate. Methods: 35 Wistar albino rats were randomly divided into five groups: Control, Acute Pentylenetetrazole group (APTZ), Acute Pentylenetetrazole+ Valproate group (AVPA), PTZ kindling group (PTZk) and PTZ kindling+ Valproate group (KVPA). Serum and brain levels of ghrelin, nesfatin-1 and FNDC5/irisin were determined with ELISA. Results: Serum levels of ghrelin were significantly decreased in APTZ and PTZk groups compared to the control (p < 0.01). There was a statistically significant decrease in brain levels of ghrelin in all groups compared to the control group (p < 0.01). There was a statistically significant increase in serum nesfatin-1 levels in the APTZ and PTZk groups compared to the control (p < 0.05). Serum levels of nesfatin-1 were similar to the control group in both the acute and the chronic treatment groups. There was a statistically significant increase in brain nesfatin-1 levels of the KVPA group compared to the control (p < 0.05). Serum and brain levels of FNDC5/irisin were found significantly increased in APTZ, AVPA and PTZk groups compared to the control (p < 0.01). Conclusions: Statistically significant alterations were detected in the serum and brain levels of these three peptides in both the PTZ-induced chronic epilepsy model and acute seizure model. The results of this study may suggest that the increase in FNDC5/irisin and nesfatin-1 levels, and the decrease in ghrelin levels may contribute to seizure pathophysiology. However, further studies are needed in order to confirm our hypothesis.
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A growing body of research suggests that physical activity, healthy eating, and music can, either directly or indirectly, have positive effects on our brain and cognition. More specifically, exercising and eating seem to enhance cognitive abilities, such as memory, creativity, and perception. They also improve academic performance and play a protective role from many degenerative diseases, including Alzheimer's disease. Concerning music, research has shown that there exists a general positive relation between music aptitude and cognitive functioning. Furthermore, the presence of music seems to create a positive mood and a higher arousal, which translates into better performance in many cognitive tasks. This literature review provides an overview of the major empirical findings in this domain. Studies on both healthy and clinical individuals are reviewed and discussed. We conclude with suggestions for educators, policymakers, people in helping professions, and any others interested in making informed decisions about possible ways to nurture their own brain or the brain of the people they are trying to help. We also provide suggestions for additional research on this important topic.
Article
As participation at remote endurance events increases, so does the need to screen participants for potentially problematic medical conditions, but this process has been ill-defined to date. This article aims to outline a general approach to screening and discusses common or important medical conditions that may need consideration in the screening process. Medical conditions that are considered low risk may translate to high-risk conditions in the setting of a remote and austere location. Medical directors of remote endurance events should have a familiarity with assessing risks and applying informed consent principles to participation. While there are no specific standards on medical disqualification from an event based on medical history alone, several systematic considerations should be made that allow for an assessment of risk to an individual for a specific event. The medical director and event director, in discussion with the athlete and treating clinician when appropriate, should come to a consensus on participation when high-risk medical conditions become apparent during the screening process. Both modifications and accommodations to participation may be used to mitigate both clinical and medicolegal risk and allow for participation.
Article
Exercise can improve cognitive function and the outcome of neurodegenerative diseases, like Alzheimer's disease. This effect has been linked to the increased expression of brain-derived neurotrophic factor (BDNF). However, the underlying molecular mechanisms driving the elevation of this neurotrophin remain unknown. Recently, we have reported a PGC-1α-FNDC5/irisin pathway, which is activated by exercise in the hippocampus in mice and induces a neuroprotective gene program, including Bdnf. This review will focus on FNDC5 and its secreted form "irisin", a newly discovered myokine, and their role in the nervous system and its therapeutic potential. In addition, we will briefly discuss the role of other exercise-induced myokines on positive brain effects.
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The book is about general information on epilepsy to educate teachers
Article
During growth and puberty profound changes in metabolic/endocrine compartments are paralleled by the maturation of various hormone systems (e. g. sex-steroid axis, bone health, lipid and glucose homeostasis). On the one hand, things often change with epilepsy and the disease per se might influence enzyme systems. On the other hand, antiepileptic drugs (AED) are well known to elicit diverse neuroendocrine changes. Data concerning the thyroid axis are far from conclusive but regular measurement of serum hormones is recommended. Monitoring of bone health in children and adolescents with epilepsy comprises a thorough evaluation of the risk profile and periodic determination of vitamin D concentrations. To achieve maximum safety, the use of an oral contraceptive containing a progestin dose above that needed to inhibit ovulation without a pill-free interval (a so-called “long cycle”) is suggested. Furthermore, the use of additional barrier methods or – alternatively – classic or levonorgestrel-releasing intrauterine devices should be taken into consideration. In the case of pregnancy, extensive instruction concerning sleep and compliance, as well as frequent determination of AED serum levels are necessary. When lamotrigine is combined with an oral contraceptive, physicians should be aware of decreasing lamotrigine concentrations, whereas mid-cycle bleedings might point towards loss of contraceptive safety. To sum up, a multidisciplinary approach is necessary to monitor possible neuro-endocrine alterations that warrant further examination and treatment, especially in adolescent girls and boys.
Article
Sport ist gesund. Er verschafft Selbstvertrauen und soziale Integration. Für kaum jemanden ist Letztere so wichtig wie für Epilepsiekranke — weil sie ihnen regelhaft versagt bleibt. Aber kann ein Anfallskranker auf ein Rad steigen, einen harten Zweikampf bestreiten oder gar ins Wasser gehen?
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Short DescriptionOnce diagnosis and therapy issues have been settled, quality of life concerns will most likely surface. Can someone with epilepsy participate in sports, which ones and what precautions should be taken? Up to one third of patients with epilepsy have some form of cognitive handicap or attention deficit hyperactivity disorder, which may contribute to a tendency for accidents. In the 1970s, physicians and family members were concerned that sport activity may worsen epilepsy and expose the person to undue risk for injury. In 1968 the American Medical Association issued a statement restricting collision sports because of possible repeated head trauma, thought to exacerbate epilepsy, only to revert to a positive position six years later. In 1983 the American Academy of Pediatrics recommended most sports for children, provided they had good seizure control and qualified supervision was available where needed. Lastly in 1997 the ILAE suggested tha ...
Article
Epilepsy is a chronic condition that may be associated with several other diseases. Psychiatric comorbidities are highly prevalent and depression is the most common type of psychiatric comorbidity in people with epilepsy. The beneficial effects of exercise for people with epilepsy have been increasingly reported, including reduction of seizure susceptibility, improvement of quality of life and reduction of depression. In this regard, we propose in this article the potential role of physical exercise to minimize depression in people with epilepsy. We summarized the most relevant data on the complex relationship between neurotransmitters and epilepsy, depression, physical exercise and subsequently proposed how a regular program of exercise can regulate depression associated with epilepsy. The significance of such a relationship has a marked impact on the development and implementation of appropriate coadjutant treatments to improve functional outcomes and quality of life in people with epilepsy.
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The role of epileptiform seizures in causing drowning and near-drowning among children was studied by examining the case reports of all 140 childhood immersion accidents that occurred in an area of Hawaii over five years. Four of the 140 immersion accidents were caused partly by epileptiform seizures, but none were fatal. The combined results of the Hawaiian and Brisbane studies (total population studied over five years 1 600 000) showed that no epileptic children died from accidents in the sea or in swimming pools; and the 2.9% incidence of immersion accidents due to seizures in the Hawaiian study compares well with the incidence found in other series. If an epileptic child is mentally normal, well controlled with anticonvulsants, and supervised in the water then the risk of drowning is very small.
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Millions of healthy people participate in sport on a regular basis. Moreover, in the last decade patients with chronic disorders have been encouraged to take part in sporting activities as a part of their rehabilitation. Can epileptic patients freely participate in sport or whether they are restricted to a certain extent by their disorder? An important factor is freedom from seizures. If seizures have been controlled for over 2 years the risk of relapse is the same as the risk of a first seizure. The risk of patients drowning or falling, or their epilepsy worsening because they are engaged in sport is thought to be low. Clinical data suggest that the incidence of seizures during sports and exercise is reduced. In the cooling down period, however, seizures tend to occur more frequently. Physicians should encourage epileptic patients to participate in sporting activities to enhance their physical fitness, self-esteem, and social integration. Before giving advice about the most suitable type of sport, the physician should know the patient’s medical history, have a good insight into the different types of sport and be able to judge the role and function of sport to the particular patient. With certain precautions virtually all sports are suitable for most epileptic patients and should therefore be encouraged. However, a small minority of hospitalised patients with severe epilepsy need the supervision of qualified trainers, coaches and volunteers.
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Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3-7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure-influencing factors were kept as constant as possible. Self-reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow-up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life-style change and that continued physical exercise for these patients requires a well-organized and supportive program, requiring experienced and dedicated instructors.
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The traditional view that epilepsy is usually a chronic condition in which the prognosis is consistently poor has been challenged in the last 2 decades. Evidence from population-based studies and from intervention studies in newly diagnosed patients has produced a wealth of information of a much better prognosis. It is now generally accepted that as many as 70-80% of people developing seizures for the first time will eventually achieve terminal remission, whereas the remaining 20-30% will continue to have recurrent seizures despite all treatment. Despite the high recurrence rate after a first epileptic seizure, remission usually occurs early and for most persons, epilepsy is a short-lived condition. The exact role of antiepileptic drugs (AEDs) in this good outcome, however, remains open to debate, because the natural history of the untreated condition is largely unknown. In this article, factors that may influence the prognosis of the epilepsies, including the problems of diagnosis, are reviewed. Special emphasis is given to the issue of spontaneous remission and the question of prognosis of different epileptic syndromes.
Article
The athletic privileges of young people with epilepsy are often restricted by parents because of fear that injury might "make the epilepsy worse," or that resulting fatigue may precipitate further seizures, or both. The public in general tends to share these views; fortunately, many physicians and educators today believe that once a patient's seizures are under reasonable control, he should lead a normal life and participate in sports and other physical activities. We have encountered many instances where parents of a child who had experienced only an occasional seizure considered him ill in the same respect as if he were afflicted with active tuberculosis or acute rheumatic fever. These children were encouraged and frequently compelled to rest and take daily afternoon naps. These attitudes should be discouraged, since they are medically unsound and often do the patient more harm than good. The parents should be instructed to allow their children
Article
To the Editor.— The Professional Advisory Board of the Epilepsy Foundation of America1 responded to an inquiry2 about scuba diving for persons with epilepsy in a recent issue. The Advisory Board of the Epilepsy Foundation of America was of the opinion that the decision as to whether a patient may scuba dive should be made by the individual with epilepsy and not by the examining physician. They also noted that, although there is an increased risk of accident or death in scuba divers, this should be an individual decision.Although one would certainly agree with their concept that the decision whether or not to participate in sports or other activities in life that are hazardous ideally should be an individual one, the examining physician is left with the dilemma as to whether, verbally or in writing, to permit or restrict diving. The patient who suffers from a seizure
Article
It is logical that anyone with seizures should not subject himself to repetitive head trauma. Unfortunately, when considering the issue of contact sports for epileptics, there is little more to go on than this apparent logic. Most physicians, in addition to regular anticonvulsive therapy, empirically recommend rest, good food, and physical and mental activity; also, they urge parents and associates to treat the patient as normally as possible.On the basis of such recommendations, the Committee on the Medical Aspects of Sports took the position in 1968 that, after a thorough medical evaluation and after medical control of the seizure disorder had been established, young people with convulsive disorders could participate in sports. The Committee, at that time, had taken the position that contact sports such as boxing, tackle football, ice hockey, diving, soccer, rugby, lacrosse, and other sports involving chronic recurring head trauma should be avoided. This advice was
Article
It is wrong to consider epilepsy as a disease and accept as a corollary the proposition that the individual with this disease either should or should not participate in contact sports. Epilepsy is a symptom rather than a disease, and the causes of epilepsy are multiple. Categorical generalization, therefore, cannot be made with validity, and the question of sports participation must be individualized on the basis of multiple factors. The following discussion attempts to assemble certain aspects, which might contraindicate participation and must be weighed against those factors favoring participation.Causes In all likelihood the most common cause of epilepsy in the age group participating in contact sports is that relating to genetic influences. It is well known, however, that genetic influences are not absolute, and that a disease is not necessarily either inherited or not inherited. The genetic factor may simply imply a predisposition. There is little question that
Article
Purpose: To compare the exercise habits in a sample of adult outpatients with epilepsy with those of a general population of the same age and sex and furthermore to study physical exercise as a seizure precipitant and the risk of sustaining seizure-related injuries while exercising. Methods: Two hundred four adult outpatients with active epilepsy responded to two questionnaires. The first one, addressing exercise habits, was a selected part of a broad self-assessing screening used every second year by a marketing and media research institute to reveal changes in the average Norwegian's lifestyle. The exercise habits of the epilepsy population were compared with those of the average population. The other questionnaire, addressing seizures and injuries related to physical exercise, consisted of eight sections and was developed at the National Center for Epilepsy in Norway. Results: The portion of those never exercising was significantly higher among the patient group compared with the average population. Otherwise, the exercise patterns were very similar in the two populations. However, the patients exercised more often in fitness centers and together with friends, whereas individual activities like skiing and swimming were more often preferred by the average Norwegian. Of the 204 patients, 53 and 63% had never experienced seizures during or immediately after exercise, respectively. About 10% of the patients claimed that they had seizures quite often in connection with exercise. However, only 2% had genuine exercise-induced seizures, here arbitrarily defined as having seizures in > 50% of the training sessions. Among those prone to have exercise-related seizures, there was a predominance of patients with symptomatic localization-related epilepsy (i.e., with an underlying structural brain lesion). Most exercise-related seizures occurred during strenuous activity. About 38% of the patients claimed to have personal experience regarding whether regular physical exercise influenced their seizure disorder; of these, 53% claimed there was no influence, 36% claimed there was a positive influence, and 10% reported a negative influence. Thirty-six percent of the patients had experienced injuries in connection with physical exercise, but in only 10% were these injuries associated with seizures. The injuries were mostly mild. Conclusions: The surveyed sample of epilepsy outpatients was more active than expected, and their exercise pattern closely resembled that of the average Norwegian population. In the majority of the patients, physical exercise had no adverse effects, and a considerable proportion (36%) claimed that regular exercise contributed to better seizure control. However, in -10% of the patients, exercise appeared to be a seizure precipitant, and this applied particularly to those with symptomatic partial epilepsy. The risk of sustaining serious seizure-related injuries exercising seemed modest.
Article
The surgical treatment of frontal lobe epilepsy (FIE) yields far less satisfactory results than that of temporal lobe epilepsy (TLE). To cope with this problem, we have introduced several new techniques, including intraoperative electrocorticography (ECoG) with sevoflurane anesthesia, corpus callostomy for diagnosis and treatment, and multiple subpial transection (MST) for eloquent cortices and extensively disseminated epileptic areas. General anesthesia was maintained by sevoflurane during surgery, and intraoperative ECoG was repeated after each procedure. When preoperative semiology suggested involvement of the bilateral frontal lobes or ECoG detected bilaterally synchronized epileptic discharges, anterior corpus callosotomy was performed before the main surgical procedure. MST was applied to unresectable motor or speech zones. This technique was also useful for treatment of widely disseminated epileptic zones. We obtained satisfactory results in surgical treatment of FLE. At >1 year of follow-up, >70% of the patients operated on have become seizure-free or almost seizure-free. Relevant combined use of ECoG, callosotomy, andor MST has proved to be very effective in achieving satisfactory surgical results for treatment of FLE, especially when preoperative magnetic resonance imaging (MRI) does not detect any structural lesions.
Article
Purpose: To assess social and physical activity by means of a controlled study based on a questionnaire and standardized clinical tests of physical fitness. Methods: In this controlled study, we assessed several issues of social and physical activity in 136 patients with epilepsy and 145 controls by using a questionnaire. In addition, we investigated physical fitness based on physical parameters such as body mass index and body composition and standardized tests of aerobic and muscle strength endurance and physical flexibility in 35 adult patients and 36 healthy controls. Results: Leisure time habits both at home and outside the home were mainly similar except for visits of friends, which were significantly reduced in patients. Although the general attitude toward sports and physical activity was positive in both groups, and although controls judged sports to be dangerous significantly more often (p = 0.007), controls participated in regular sports significantly more frequently (p = 0.005). The clinical study demonstrated a lack of physical fitness, as suggested by the questionnaire data. Statistical analysis demonstrated significant differences of aerobic endurance (p < 0·001), muscle strength endurance (p < 0.001), and physical flexibility (p < 0.001) in favor of the control subjects. The body mass index was significantly higher in patients (p = 0.03), whereas the body composition revealed a higher body fat ratio only in female patients (p − 0.04). Conclusions: We conclude that patients with epilepsy suffer from a considerable lack of physical fitness that might have an important impact on their general health and quality of life. In addition to overprotection and reduced mobility, the questionnaire revealed insufficient knowledge among health professionals and sport instructors as a major factor contributing to these results.
Article
Two neuronal calcium-binding proteins, calbindin-D28k (CaBP) and parvalbumin (PV), were localized in the normal rat hippocampus by using immunocytochemical methods to determine (1) their location and (2) whether a correlation exists between the presence of these two calcium-binding proteins and the selective vulnerability of different hippocampal neuronal populations to experimental seizure activity. CaBP-like immunoreactivity (CaBP-LI) is present in all dentate granule cells and some, but not all, CA1 and CA2 pyramidal cells. Some CA1 pyramidal cells lack CaBP-LI, and those that do are lightly stained compared to the dentate granule cells. CA3 pyramidal cells appear to contain neither CaBP- nor PV-LI, and no granule or pyramidal cells exhibit PV-LI. CaBP-LI is present in distinct populations of dentate and hippocampal interneurons but absent from others. In area dentata, CaBP-LI is present in a small number of interneurons of the molecular and granule cell layers and in a small population of presumed basket cells in or below the granule cell layer. Conversely, more presumed dentate basket cells exhibit PV-LI than CaBP-LI. In the hilus of area dentata, few cells are CaBP- or PV-immunoreactive. The hilar somatostatin/neuropeptide Y (NPY)-immunoreactive cells and hilar mossy cells, two distinct and large populations, lack CaBP- and PV-LI. In the CA3 region, CaBP-LI is present in a relatively small number of interneurons in each stratum. PV-immunoreactive interneurons in area CA3 are more numerous. In area CA1, CaBP-LI is present in many interneurons in strata radiatum and lacunosum-moleculare. Some, but relatively fewer, CaBP-positive interneurons are present in strata pyramidale and oriens. Conversely, PV-immunoreactive interneurons are numerous in strata pyramidale and oriens but rare in strata radiatum and lacunosummoleculare. Staining with the particulate chromagen benzidine hydrochloride revealed a previously undescribed dense band of CaBP-LI in the inner dentate molecular layer, a lamina enriched with kainate-displaceable glutamate-binding sites and innervated by the apparently excitatory ipsilateral associational/commissural (IAC) pathway that originates in the CaBP-negative hilar mossy cells. Bilateral electrical stimulation of the perforant path was performed in order to destroy the hilar mossy cells and to determine if this band of CaBP-LI is normally present within the mossy cell terminals. Perforant path stimulation that destroyed hilar mossy cells throughout the dorsal portions of both hippocampi did not abolish the dense CaBP-like immunoreactivity in the inner molecular layer. In summary, the cell populations visualized by immunocytochemical staining for CaBP- or PV-LI are clearly distinct. All of the relatively seizure-resistant dentate granule cells and many basket cells and hippocampal CA2 pyramidal cells are darkly stained for either CABP- or PV-LI. The seizuresensitive dentate hilar somatostatin/NPY-positive cells, hilar mossy cells, and hippocampal CA3 pyramidal cells appear devoid of both CaBP- and PV-LI. The seizure sensitive CA1 pyramidal cells are devoid of PV-LI and exhibit less CaBP-LI than the seizure-resistant granule cells. Therefore, a positive correlation exists between the presence of at least one of these calcium-binding proteins in hippocampal neurons and their relative resistance to seizure-induced neuronal damage. These data suggest that the relative vulnerability of different cell populations may be related to differences in the concentration of cytoplasmic proteins capable of sequestering free intracellular calcium.
Article
Repeated daily electrical stimulation of the amygdala can lead to a progressive increase in brain and behavioral seizures. This phenomenon, termed kindling, has been viewed as a model for epileptogenesis. The results reported here demonstrate that a single systemic epinephrine injection can significantly retard such epileptogenesis for a period of at least several days. These findings suggest that peripheral catecholamines, responding either to stress near the time of seizure initiation or to treatments administered at that time, may be important in regulating the development of epileptic states. In addition, the results indicate that an acute episode of high plasma epinephrine levels may result in a durable modification of brain function.
Daily electrical stimulations of the amygdala and hippocampus at intensities sufficient to evoke after-discharges (ADs) resulted in the development of motor seizures, which could not initially be evoked by these stimulations. The triggering of ADs was critical for this development, as well as for the development of permanent changes in the characteristics of the AD. The wave form of the AD "spikes" became more complex. The frequency of these spikes and the duration of AD increased. The amplitude of the AD spikes increased in the structure stimulated as well as in secondary structures to which the AD was "projected". This increase in amplitude of "projected" spikes often correlated with the appearance of motor seizures. Other electrographic developments are discussed including the appearance of spontaneous "inter-ictal" spiking in the amygdala. It was found that the development of motor seizures by stimulation of the amygdala resulted in an increased ability of the contralateral amygdala, and the septal area, but not of the hippocampus, to drive motor seizures when stimulated ("transfer"). Motor seizure development in the hippocampus transferred to the contralateral hippocampus. These developments were shown, by means of control subjects, with lesions in the primary focus to involve changes outside the primary focus. The implications of these developments with respect to seizure development are discussed.
Article
Epileptic patients are frequently advised not to participate in sports. This restriction hampers the lives of many young people, without clear evidence of its necessity. Data are presented here on 5 patients seen in the epilepsy clinic who had seizures while engaging in sports. These were the first seizures to have occurred in three of the patients. The physiologic alterations involved in sports which could lead to seizure are emotional stress, hyperventilation and elevation of body temperature. On the other hand, the physical activity itself, through release of catecholamines, may elevate the convulsive threshold. From an analysis of these five cases, it is concluded that restriction of participation in sport is not necessarily to the benefit of most epileptic patients. Participation in sport should rather be evaluated on an individual basis.
Article
The pattern of hippocampal cell death has been studied following hippocampal seizure activity and status epilepticus induced by 110-min stimulation of the perforant pathway in awake rats. The order of vulnerability of principal cells in the different hippocampal subfields--as determined by silver impregnation--was found to be very similar to the pattern found in ischemia; i.e., dentate hilus greater than CA1, subiculum greater than CA3c greater than CA3a,b greater than dentate granule cells. The hilar somatostatin-containing cells were the most vulnerable cell type, whereas all other subpopulations of nonprincipal neurons--visualized by immunocytochemistry for the calcium binding proteins parvalbumin and calbindin--were remarkably resistant. Pyramidal cells in the CA3 region containing neither of the examined calcium binding proteins were more resistant to overexcitation than CA1 pyramidal cells, most of which do contain calbindin. This indicates that no simple relationship exists between vulnerability in status epilepticus and neuronal calcium binding protein content, and that local and/or systemic hypoxia during status epilepticus may be responsible for the ischemic pattern of cell death.
The aim of this study was to compare the effects of a physical exercise test and of voluntary hyperventilation between controls and children with absence epilepsy. Eighteen children (6 controls and 12 epileptics) were studied during rest (R), a maximal physical exercise test (15 min; PE), recovery (REC) and voluntary hyperventilation (3 min; VHPV). EEG and ECG were recorded during the experiment; respiratory parameters were measured to quantify PE; plasma levels of pH, lactate, pyruvate, glucose and antiepileptic drugs were determined. A decrease in the number of absences was observed during PE whereas an increase was observed during VHPV. We found significant positive correlations between the number of children with absences, the total number of absences for each state, frequency of absences per minute and the corresponding mean plasma pH, which demonstrate that the lower the pH is, the fewer absences occur. On the other hand, there was no relationship between the number of absences and the values of other parameters. Relations between variations of the plasma value of the pH, and thus the probable cerebral value of pH, and neuronal excitability are discussed. Our results indicate that children who suffer absence epilepsy should not be discouraged from sport practice.
Article
This paper describes the distribution of structures stained with mono- and polyclonal antibodies to the calcium-binding proteins calbindin D-28k and parvalbumin in the nervous system of adult rats. As a general characterization it can be stated that calbindin antibodies mainly label cells with thin, unmyelinated axons projecting in a diffuse manner. On the other hand, parvalbumin mostly occurs in cells with thick, myelinated axons and restricted, focused projection fields. The distinctive staining with antibodies against these two proteins can be observed throughout the nervous system.
Article
It is well known that professional boxers can develop chronic traumatic encephalopathy (dementia pugilistica) due to repeated head trauma. Beside CT findings indicating cerebral atrophy, the presence of a cavum septum pellucidum has been reported to indicate encephalopathy. CT findings in amateur boxers are not as well documented. The aim of this study was to find out if morphological changes could be demonstrated among former amateur boxers using CT and MRI. Two control groups of soccer players and track and field athletes in the same age-range were used for comparison. No significant differences in the width of the ventricular system, anterior horn index, width of cortical sulci, signs of vermian atrophy, or the occurrence of a cavum septum pellucidum were found between boxers and controls. A cavum septum pellucidum was found more often in the controls than in the boxers and is probably not a sign of earlier head trauma. MRI confirm no more findings than CT in this retrospective study.
Article
Twenty-one adult in-patients (11 women, 10 men, aged 18-39 years) with uncontrolled epilepsy participated in a 4-week intensive physical training program, exercising for at least 45 min three times a day, 6 days a week, at an intensity of minimum 60% of maximum oxygen uptake (maximum VO2). The program induced a considerable increase in maximum VO2 (mean 19%). Beneficial psychological and social effects were also recorded. The average seizure frequency during the 4-week exercise period was compared with 2 preexercise and 2 postexercise weeks. There was no significant difference, but there was considerable variation among patients. Only six patients had seizures during exercise. The occurrence had no relation to seizure type, mode of activity, or pulse rate. We conclude that physical activity does not represent an important seizure-inducing factor in general, and that in most people with epilepsy physical training appears to have a favorable influence. The exact mechanism behind this influence is not known, but physiologic as well as psychological and social effects may be of importance. Physical training did not change the serum levels of the antiepileptic drugs to a clinically important degree.
Article
By means of a questionnaire, we analyzed leisure time habits of 44 adult in-patients with active epilepsy (i.e., at least one seizure a month for the last year). Twelve patients had a generalized epilepsy and 32 a partial epilepsy. All received antiepileptic drugs (AEDs), and none had additional handicaps. Despite good facilities in their surroundings for participation in social, cultural, and physical activities, most patients lived a sedentary life. Social contact was limited, and they were only half as active physically as the average Norwegian population of comparable age and sex. Work capacity was tested as maximum oxygen uptake, using the bicycle ergometer test. Maximum oxygen uptake was considerably lower (75-80%), and the decrease observed in aerobic capacity with increasing age was more pronounced than that of the average Norwegian population. In comprehensive care of patients with epilepsy, we believe that prescription of adapted physical activity is an important means of improving quality of life.
Article
The effect of exercise on seizure frequency is uncertain. While some investigators have reported an increase in the normal background frequency of EEGs after exercise, other investigators believe that exercise increases EEG epileptiform activity in the recovery period following exercise. We asked all patients over a two month period at our outpatient Epilepsy Clinic to complete a questionnaire regarding their exercise habits. Those who were not otherwise healthy, were non-compliant with their medications, or whose blood levels were not therapeutic were eliminated from the analysis. Utilizing the complex Chi-square method, it was determined that patients who participated in some form of exercise had significantly fewer seizures than those who did not exercise (p less than 0.05). Conclusions from this brief study indicate the need for a more comprehensive trial, including EEGs, biochemical studies, and fitness evaluations, to determine the effects of an exercise program on seizure frequency.
Article
It was hypothesized that endurance exercise results in an alteration in the brain monoamine systems. Rats were trained to run for food reinforcement on a variable ratio schedule in running wheels. Yoked control rats were also allowed to run but were not specifically reinforced for running. The animals ran 5 days per week for 8 weeks and were sacrificed 48 hours after the last endurance training session. The brains were assayed for norepinephrine and dopamine concentrations and beta-adrenergic (3H-dihydroalprenolol binding) and dopaminergic (3H-spiroperidol binding) receptor densities. Changes in norepinephrine concentration and beta-adrenergic receptor densities were not significantly different between reinforced running and yoked control groups. Dopamine concentrations were significantly higher while dopamine receptor densities were significantly lower in the reinforced running group. These results suggest that chronic running elevates dopamine secretion and consequently produces a compensatory down-regulation of dopaminergic receptor sites. The relationship of these changes to motor activity and to the antidepressant effects of exercise are discussed.
Article
Three patients had a clinical history of epileptic seizures during exercise. In all three patients, generalized epileptiform EEG abnormalities were activated by exercise, whereas none had paroxysms during resting wakefulness or during hyperventilation, and only one had a paroxysmal discharge during sleep. Advice to epileptic patients about physical activity should be based on a careful history of individual tolerance. In doubtful cases, an EEG recorded during exercise can provide evidence for an epileptic mechanism.
Article
The effect of DSP4, a noradrenergic neurotoxin, on hippocampal kindling were examined in rats. The depletion of NA induced by intraperitoneal injection of DSP4 (50 mg/kg) facilitated the rate of hippocampal kindling by reducing the time spent in stage 2. The number of wet-dog shakes was also reduced in experimental animals during kindling stages 1 and 2 compared to control group. The results indicate that in DSP4 treated rats there is a more rapid activation of structures involved in the propagation of the local limbic seizure to motor centers responsible for the behavioral manifestation of the seizure, which is due to the NA depletion.
Article
It is necessary nowadays to discourage the parents of epileptic children from unduly restricting their activities, rather than warning them of all the possible hazards of sports and other physical exertions. It is stated in this paper that fresh air, sunshine and exercise favorably affect the course of epilepsy, and that fits are less likely to occur during physical activity than at rest. On the basis of clinical observations on 15,000 young children with epilepsy, it is recommended that no barriers should be placed to prevent such patients participating in all sports including tackle football, boxing and wrestling. There is no evidence that mild head injuries such as may be expected in these sports have any deleterious effect on prognosis, and any slight risk there may be is less than the risk of making epileptic children feel abnormal and outcast.
Article
Alterations in gas exchange were studied in man during exercise increasing in increments of 5 w each minute, to determine the noninvasive indicators of the onset of metabolic acidosis (anaerobic metabolism). Expired airflow and CO2 and O2 tensions at the mouth during the breath were continuously monitored with rapidly responding gas analyzers. These measurements were recorded directly as well as processed by a minicomputer, on line, to give minute ventilation (VE), CO2 production (VCO2), O2 consumption (VO2), and the gas exchange ratio (R), breath by breath. The anaerobic threshold (AT) could be identified by the point of nonlinear increase in VE, nonlinear increase in VCO2, an increase in end tidal O2 without a corresponding decrease in end tidal CO2, and an increase in R, as work rate was increased during an incremental exercise test. Of these measurements, R was found least sensitive. The AT was determined in 85 normal subjects between 7 and 91 yr of age, by these techniques. The lower limit of normal was 45 w (VO2 = 1 liter/min) while values for very fit normal adults were as high as 180 w. The patients studied with cardiac disease above functional class I have lower anaerobic thresholds than the least fit normal subjects. The 1 min incremental work rate test is associated with changes in gas exchange which can be used as sensitive on line indicators of the AT, thus bypassing the need for measuring arterial lactate or acid base parameters to indicate anaerobiosis.
Article
Convulsive seizures were kindled in rats by repeated stimulation of the amygdala, and the subjects then received intracerebral injections of 6-hydroxydopamine into the dorsal noradrenergic bundle. Although this treatment severely depleted noradrenaline, there was no effect on the intensity or duration of seizures, suggesting that noradrenaline does not regulate kindled seizures when they have developed.
Article
This study examines the effects of major life events, daily hassles and uplifts, and daily stress levels as they increase or decrease the risks of having seizures and estimates risk ratios for specific stressors and perceived stress levels. Utilizing a prospective design, 12 adults with severe epilepsy monitored the occurrence of seizures, stressors, and stress levels over a 3-month period. In within-individual analyses, high stress levels and stressful events were associated with more frequent seizures for most participants. The association between higher stress levels and increased seizures was confirmed in group analyses. This study provides empirical evidence of the association between stress and seizures and describes the use of a statistical model that is useful for investigating risk factors as they influence physical and mental illness.
Article
There have been a number of recent reports describing water intoxication in infants.1-4 In each case, hyponatremia followed an excessive intake of free water, either as the result of feeding mismanagement1-3 or vigorous hydration with water during a febrile illness.4 This report describes an infant who developed hyponatremia and seizures after swallowing an unknown volume of water during a swimming lesson. We will discuss the case and comment on present recommendations for preschool swimming instruction. CASE REPORT An 11-month-old girl was in excellent health until the day of admission. During a 60-minute swimming lesson, she was noted to swallow more water than usual, but exhibited no unusual symptomatology while in the pool.
Article
Adults with epilepsy completed self-report measures of exercise participation, barriers to exercise, stressful life experience, depression, and general psychosocial adjustment (n = 133) as part of routine outpatient visits. Descriptive statistics showed lower levels of depression among patients who exercised regularly. Structural equation analyses confirmed the fit of a path model that included significant direct effects of exercise and stressful life experience on depression. These effects were independent of each other, and independent of the influence of other predictor variables, such as seizure frequency, age, and gender. Stressful life experience also had a direct unique effect on seizure frequency in the multivariate models. These results suggest that problems with depression, which are common in adults with epilepsy, are significantly lower among those who exercise regularly and avoid stressful life change.
Article
We performed MRI volumetric measurements of the amygdala (AM) and hippocampal formation (HF) in a group of 43 patients with temporal lobe epilepsy not controlled by optimal drug treatment. Fifteen patients (35%) had a history of prolonged febrile convulsions (PFC) in early childhood; 30 patients underwent surgery, and histopathology was available in twenty-four. The mean values of AM and HF volumes ipsilateral to the EEG focus were significantly smaller than those of normal controls. The volumetric measurements showed a more pronounced atrophy of the AM in patients with a history of PFC, although the HF volumes were also smaller in this group. Patients with a history of PFC had a higher proportion of more severe mesial temporal sclerosis (MTS) compared with those with no PFC. These findings confirm a correlation between early childhood PFC, the severity of atrophy of mesial structures, and MTS.
Article
Most currently available antiepileptic drugs (AEDs) were developed by testing new compounds in animal models of seizures. Increased knowledge of the cellular and molecular mechanisms underlying normal CNS function and seizure phenomena is now being used to design new AEDs specifically to interfere with epileptic mechanisms. Focal epilepsy develops in areas of cortex that are damaged and in which aberrant recurrent excitatory circuits develop, producing spike discharges in the EEG. Occasionally, normal membrane conductances and inhibitory synaptic currents break down and excess excitability spreads, either locally to produce a focal seizure or more widely to produce a generalized seizure. Both original synchronous activation and seizure spread appear to utilize normal synaptic pathways and mechanisms. Much new development of AEDs is targeted at modulating these excitatory and inhibitory synaptic effects, focusing directly on multiple components of glutamate and GABA receptors. Intrinsic, voltage-dependent currents are also involved in the pathophysiology of epileptic processes. Calcium currents act to amplify excess neuronal depolarization during hypersynchronous activation, are involved in neurotransmitter release, and play a role in the development of longer-term changes in synaptic efficacy, which may be involved in some seizure phenomena. They also appear to be involved in some forms of primary generalized epilepsy, in which burst discharges due to calcium currents in deep diencephalic neurons with widely ramifying axons may act as synchronizing influences. Neuromodulatory agents, including purines, peptides, cytokines, and steroid hormones, also play important roles in regulating brain excitability. Adenosine in some experimental models act as an endogenous antiepileptic substance, and agents that enhance the actions of adenosine are often antiepileptic in animal models.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Two children with seizures induced by physical exercise are described. Epilepsy was present from early childhood (age: 4 and 5 months), but the precipitating effect of exercise became evident only later (age: 20 months and 3.5 years). Several treatment regimes were tried, but no satisfactory seizure control could be achieved. In both children no etiological factor was known. MRI, CT and repeated interictal waking and sleeping EEG recordings were normal. Hyperventilation and photostimulation had no effect on the EEG. Physical exercise (e.g., playing football) induced clinical seizures and generalized epileptiform EEG abnormalities as recorded by ambulatory cassette EEG (Oxford). Cardiac arrhythmias were excluded by concomitant EEG recording. Extensive metabolic and endocrinologic investigations during and after seizure induction gave normal results. Thus, the pathophysiologic mechanism for exercise-induced seizures remained unclear.
Article
To clarify the risks of drowning for children with epilepsy we have studied the records of the 306 children who drowned or nearly drowned in the UK in 1988 and 1989. Ten children with incidents related to epilepsy presented over the study period, four of whom drowned. Children with epilepsy had a higher incidence of submersion accidents but no child participating in supervised swimming drowned. Two children died in the bath. Five children had special needs. We conclude that children with epilepsy can enjoy swimming with a friend in a lifeguard supervised swimming pool. They should be encouraged to shower in a non-glass cubicle rather than have a bath. The bathroom should remain unlocked. Children with poorly controlled epilepsy or associated learning difficulties are at a higher risk from all accident trauma. They need a very high level of supervision while swimming and advice should be given on an individual basis according to what is considered realistic for that child.
Article
To determine the demographic characteristics and risk factors associated with death from drowning among people with epilepsy. Retrospective review of medical examiner's investigations into deaths from drowning from Jan. 1, 1981, to Dec. 31, 1990. Alberta. Personal data, medical history, circumstances surrounding the death, autopsy findings and results of postmortem toxicologic analyses. Of 482 deaths from drowning in Alberta during the study period, 25 (5%) were considered by the medical examiner's office to be directly related to seizures. Fifteen (60%) of the 25 deaths occurred while the person was taking a bath, unsupervised. Only one person (4%) died while taking a shower. The remaining deaths occurred on a river or lake (16%), in a private pool (8%), in a public pool (8%) and in a jacuzzi (4%). Two people fell out of moving boats while having a seizure; neither had been wearing a personal flotation device. Nineteen (83%) of 23 people who had been receiving anticonvulsant drug therapy had undetectable or subtherapeutic levels of one or more of the drugs at autopsy. Ethanol was not a factor in any of the deaths. Seizure-related drownings represent a small but potentially preventable proportion of all drownings. Enhanced seizure control and compliance with anticonvulsant drug therapy may prevent some of these deaths. In addition, all people with epilepsy, regardless of the level of control of their condition, should be encouraged to take showers while sitting instead of baths. The presence of people in the same house who are not directly supervising the person in the bathroom does not protect against drowning. Personal flotation devices should be worn at all times during boating activities.
Article
Sport and epilepsy are not mutually exclusive, providing the disease has been properly diagnosed and managed and adequate safeguards are taken. The author also outlines specific contraindications for the sports-minded person with epilepsy.
Improved neurodiagnostic tools for examining cerebral structure and function have greatly enhanced the safety and efficacy of surgical treatment for epilepsy, and markedly increased the number of candidates for these surgical interventions. The application of new developments in clinical neurophysiology, as well as recent advances in neuroimaging, for surgical therapy of medically refractory seizures are reviewed. Improvements in surgical results are documented and future directions are discussed.