Universiteit Stellenbosch
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Epilepsy and Exercise: What we should know!
Outeur: Dr. Helene van der Hoven
Gepubliseer: 02/02/2021

​People around the world are engaging in various forms of physical exercise.  They are active, keeping fit & participating in the sports they love...

But, what if you or one of your friends are one of the 50 million people world-wide that have been diagnosed with epilepsy – is such a lifestyle still possible?  Can you still participate in physical exercise and sports, are there certain precautions that should be taken or certain activities/sports that should be avoided and what are you to do if someone has a seizure on the sporting field? 

Let's look at the facts of epilepsy and exercise and answer some of these questions:

What is a seizure & when is it epilepsy?

A seizure occurs when a person experiences a sudden episode of dysregulation of the normal electrical activity in their brain and this can manifest in various ways, such as in “staring spells", strange, repetitive or jerking movements, stiffening or relaxing of the muscles etc. and may or may not be accompanied by the loss of consciousness.  Episodes can last anything from seconds to a couple of minutes and are usually self-limiting.   Preceding “auras" in the form of “a funny feeling" or sensory awareness and post-event tiredness, sleepiness and/or confusion is common. 

Seizures can be caused by various conditions (infection, fever, toxins, strokes, trauma, electrolyte abnormalities etc.), mimicked by others (e.g. migraine, other causes of losing consciousness etc.) A single episode (experienced by 8-10% of all people during their lifetime) is not necessarily the same as epilepsy.  The diagnosis is only considered once the seizures become recurrent, and other possible causes have been excluded.  A registered medical doctor will follow a process of thorough evaluation, special investigations and follow-up before diagnosing and classifying the condition according to International guidelines.  Various medications (individually tailored) are available to treat the condition and about 49% of people (if they take their medication correctly) will be able to control their seizures on a single drug.  In about 17% of individuals, two or three drugs may be needed. 


Can someone with epilepsy still exercise and participate in sport?

Evidence has shown that people with Epilepsy are often less active than their peers.  Reasons for this are multiple and include prejudice, unawareness, stigma, fear of having a seizure, overprotectiveness of loved ones etc. It has however also shown that people with epilepsy (if they take the right precautions) do not experience more injuries than those without and that sports participation does not affect treatment effectiveness.

Some people even experience better seizure control when they do exercise and therefore physical activity should ideally be part of a comprehensive treatment plan.  Only about 10% of individuals (mostly with a certain type of epilepsy) experience exercise as a pure seizure-trigger, but your doctor should be able to help you identify if this might be true for you.

Those with epilepsy also benefit from all the psychological benefits of exercise and exercise has also been proven to specifically aid in the management of mood disorders and suicidal thoughts. These have been shown to be associated with the condition and certain of the medications used to treat it.

Are there any precautions that needs to be taken when someone with epilepsy engages in exercise or participates in sport?

  • Medical clearance needs to be obtained before participating.
  • Seizures need to be well controlled and treatment adhered to.
  • Training-buddies are great, and it would wise not to exercise alone.
  • a Medic-Alert bracelet identifying the condition is recommended.
  • “Fragile states" that predisposes to seizures should be avoided:

Certain elements related to exercise and sport are known to cause “fragile states", that can predispose one to seizures.  Things like exhaustion, increased stress, sleep deprivation, low blood sugar, overheating and dehydration are all best avoided during training, travel and competition.  The use of alcohol and recreational drugs can also contribute to the development of such a state.  

  • It is advisable that your coaches, trainers and trusted training buddies are informed of your condition and equipped with “rescue medication" and an emergency action plan.
  • “Rescue medication" in the form of buccal Midazolam or Lorazepam (your doctor can issue you a script) should be at hand during training and competition.
  • ​All Cannabinoids (natural and synthetic) are prohibited in-competition by the World Anti-Doping Agency and self-medication with Marijuana (even though practised by some people with epilepsy) is not advised and illegal in sport.

Are there certain activities/sports that should be avoided by someone diagnosed with Epilepsy?

One of the main determinants of whether a sport is safe, is the potential risk of injury, should a seizure occur during participation.  Possible treatment side effects (especially those that can alter concentration, alertness, cognition and motor skills etc) also raise concern in terms of safety and should be discussed with, and cleared by your doctor prior to participation.

​Sports that are not allowed under any circumstances include:

  • Rock climbing
  • Hang gliding
  • Pistol shooting
  • Scuba diving
  • Archery
  • Skydiving, parachuting
  • Motor racing

Sports that are allowed with strict supervision include:

  • Swimming
  • Cross-country skiing
  • Backpacking
  • Cycling

What should I do if someone has a seizure while exercising or participating in sport?

Occasionally someone can experience seizures on the sports fields.  This can be a scary experience for all involved, but it is important to remember that they are rarely life threatening and generally self-limiting.  It is important to remain calm, to make sure that the environment is safe and to call for help.  The most competent person in the immediate vicinity should execute the following straight away:

  • Ensure that the person having the seizure has an open airway, is breathing adequately and has a regular pulse.  If not address it accordingly.
  • Regularly reassess to make sure it remains this way.
  • Closely observe the seizure activity so that it can be described to the medical team.
  • Protect the persons dignity and reassure and redirect any “onlookers"
  • As soon as the seizure activity allows and if there is no risk of potential neck injury (in the event of contact sport or a fall), turn the person on their side into the “recovery position" to keep the airway clear of secretions and vomit.

Seizures lasting more than 5 minutes can be dangerous and if “rescue" medication is at hand, it can be administered by a non-medical person.  People are often scared to do this, as they fear it might affect the patients breathing, but evidence has shown that the risk of harm in not giving it is greater than the risk involved with a prolonged seizure.

If seizures do not terminate, a second dose can be administered 5 minutes later by a medically trained individual only.  Further treatment involves advanced emergency medical care.

What's the bottom line?

Overall, the majority of exercises and sports (contact and non-contact) are considered safe for people diagnosed with epilepsy.  With adequate seizure control and the right precautions, there should rarely (other than for those sports clearly contra-indicated), be reason for individuals with epilepsy to sit on the side-lines and be deprived of the physical-, cardiovascular-, mental- and  emotional- benefits appropriate physical activity has to offer.  Therefore, take control, get moving & live more!!!!

#no-prisoner #epilepsy-warriors # lifestyle-choosers

For more information, advice and assistance, contact Campus Health Service and make an appointment to see one of our physicians.

Stellenbosch Campus: (021) 808 3494/6 or Tygerberg Campus: (021) 938 9590