Physical Activity in children and teenagers with epilepsy
SYRMOU E., SYRMOS N., SYRMOS C.

Epilepsy is a common disease found in 2% of the population, affecting both old and young people. Epilepsy is one of the most common neurological disorders of childhood, affecting <1% of the pediatric population. Physical activity in young people with epilepsy has been proven to provide both physiological and psychological benefits. However, despite these positive effects of exercise, young people with epilepsy often hesitate to participate in certain types of physical exercise because of potential concerns about seizure induction or injury^1,3,4.

It is true that among the many people with epilepsy, few incorporate exercise into their daily programme. The lower amounts in participation in physical activity in adolescents with epilepsy do not appear to be due to parental restrictions. The most common reasons, reported by parents for this inactivity were either a lack of interest or being too lazy to be involved in any type of sports activity^7,8.

It may seem logical to place restrictions on athletes with epilepsy, but there are no studies to suggest that even contact sports exacerbate seizures. Recent research studies show that exercise reduces seizure frequency and improves cardiovascular and psychological health in teens with epilepsy despite the fact that teens with epilepsy seem to be less physically active than their siblings. These studies show that physical activity in children and teenagers with epilepsy has improved their quality of life and helped them to have a better seizure control^1,5,6.

The evidence shows that children and teenagers with good seizure control by antiepileptic therapy can participate in contact and non-contact sports, without adversely affecting seizures frequency. Thus, sports participation should generally be encouraged for epilepsy patients. The risk-benefit analysis for an individual patient is highly dependent on the athletic activity considered; type of seizure, the likelihood that a seizure will occur during the activity and comorbid conditions^11,18.

The majority of sports are safe for epileptics to participate in, with special attention to adequate seizure control, close monitoring of medications and preparation of family, coaches or trainers. Contact sports including football, basketball have not been shown to induce seizures and young athletes with epilepsy should not be precluded from participation. Water sports and swimming are felt to be safe if seizures are well controlled and direct supervision is present. Additional care must be taken in sports involving heights such as gymnastics and horseback riding. Sports like scuba diving or free climbing are not recommended because the risk of severe injury or death is high, if a seizure were to occur during the activity^5,6,16,18.

We should always have in mind that lack of physical activity has multiple repercussions. Most studies have suggested that adults with epilepsy have lower rates of physical fitness and elevated body mass indices (BMI).Young people with epilepsy, who are not physically active, may run an increased risk for obesity, hypertension, diabetes and heart disease. Poor physical fitness and obesity place children at risk for heart disease, stroke attacks, arthritis and diabetes. The psychological and social benefits of exercise, such as improved self-esteem, improved mood and decreased stress and anxiety, are lost as well^3,13.

Programmes that promote exercise and physical activity in adolescents with epilepsy should be encouraged to improve physical, psychological and social well-being. Participation in physical activity may improve social integration, leading to improve quality of life in children and teens¹⁸.

Clinicians should encourage participation in recreational and physical activity programmes, particularly those that also promote interaction with peers. Recreational and physical activity programmes will reduce epilepsy-related comorbilities and improve well-being: physically, by preventing the development of diabetes, hypertension and heart disease; socially, by improving self-esteem and social integration; and psychologically, by lessening anxiety and depression^5-7,18. Encephalos 2008, 45(4):226-232.

Key words: Epilepsy, physical activity, teenagers, children, seizure control, sports.