In essence, most sports and physical activities are appropriate for people with epilepsy. General fitness training in a gym is ideal, as there are others around and the activity is indoors and away from road traffic. Most team sports are fine, including contact/collision sports like rugby. Normal safeguards for participation should be followed. A few sports and activities should be contraindicated – see panel.
There are some simple pieces of advice for the person with epilepsy who exercises.
• Remain well hydrated and drink according to thirst during an event.
• Do not miss meals, and eat a nutritious, well-balanced diet that contains sufficient micronutrients.
• Avoid exercise with an intercurrent infection.
• If you experience a concussion, you must get checked out by a doctor before returning to competition. (This applies to all players with a concussion, not just those with epilepsy.)
It is important patients inform family, friends, team mates and coaches about their condition, and these people should understand what to do in the event the patient has a seizure. For lay people, this can be a frightening event, and even brief seizures lasting less than a minute seem to go on forever for the person witnessing them. Bystanders should remove nearby objects to prevent the person striking them and, once the convulsion ceases, put the person into the recovery position. If the seizure lasts for more than five minutes, medical assistance should be summoned. It is normal to have a postictal phase of confusion for maybe half an hour, so this should not be of major concern.
Finally, there are some occasions when there may be an underlying condition contributing to the seizures. Seizures may be in the presence of a syncopal episode. The best management for syncope occurring in the sporting context is to lie the person down and elevate their legs, so bloodflow returns to the brain. These people usually “wake up” within seconds and make a rapid recovery within a minute or two. Well-meaning bystanders should be discouraged from trying to prop the person up.
The other condition to be aware of is long QT syndrome. This is often associated with a family history of the condition or unexplained death in a family member at a young age. The resting ECG is diagnostic of the condition.
In summary, epilepsy is a lifelong condition, but good seizure control can usually be established and maintained with regular medication. A healthy lifestyle should be maintained, and exercise is a part of that. There is a lot of public fear regarding epilepsy; however, enabling a person with epilepsy to continue with sport and physical activity is a significant part of their remaining integrated in society. See also the recent article How to Treat Epilepsy in New Zealand Doctor, 30 August.
Chris Milne is a sports physician in Hamilton