Sports Participation in children with epilepsy

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Sports Participation in
Children with Epilepsy
Stefanie Jean-Baptiste Berry, MD
Northeast Regional Epilepsy Group
Pediatric Neurologist/Epileptologist
Introduction
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Recurrent unprovoked seizures  epilepsy
Epilepsy is a common disease found in 2% of
population, affecting both young and old
3 to 6 million Americans with epilepsy
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Chronic, severity and prognosis is variable
60 – 80% unknown etiology
Up to 80% well controlled on 2 or fewer
anti-epileptic medications
Classification of Seizures
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Seizure types:
Generalized
Focal (Partial)
Focal with secondary generalization
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Generalized Seizures:
1.) Generalized tonic-clonic (grand mal)Unconscious, whole body shaking; variable
duration
2.) Absence (petit mal) – Staring, unawareness,
brief (seconds)
3.) Myoclonic – Brief jerk of arm or leg
4.) Atonic – Sudden drop
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Focal (Partial) Seizures:
1.) Simple – Consciousness preserved;
twitching of one side of face or body,
numbness, visual
2.) Complex – Impaired consciousness;
twitching, head/eye deviation etc.
History of Sports and Epilepsy
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A stigma associated with epilepsy has
prevented involvement in sports and
recreational activities for years.
More recently, a more permissive approach has
been taken towards children with epilepsy and
their participation in sports
New evidence suggests benefit from exercise
without increased risk of injury or increased
seizures
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Due to stigma associated with epilepsy, those
with epilepsy have poorer self-esteem
Restricting child from participating in sports
led to isolation from peers and lower selfesteem
AAP – risks of sports should be weighed
against psychological trauma resulting from
unnecessary restriction
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1968 – Based on AMA position, physicians
recommended restricting the activity of those with
epilepsy
1973 – Articles presenting arguments both for and
against allowing participation in contact sports
1983 – AMA and AAP recommended participation in
most sports including contact sports (well controlled
seizures and proper supervision)
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Despite progress, most studies show children
with epilepsy are 50% less active than those
without
Unnecessary restrictions are set for fear of
injury or induction of seizure activity
Multiple studies have found that physical
exercise actually decreases seizure frequency
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Potential for injury exists but not significant
One study showed no difference in the number
of accidents that children with epilepsy had
during sporting events compared to those
without epilepsy
However, 27% of patients with epilepsy who
had seizure with sports sustained injuries
related to seizure
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Those with epilepsy are 4 times more likely to
have submersion accidents  drowning or
near-drowning
Sports involving heights can increase risk to
participant and others
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Rare cases of exercise-induced seizures
One study found 247 out of 400 people with
epilepsy could identify precipitant
Only 2 out of 400 identified physical exercise
as a precipitant
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Playing, whether organized sports or in
recreational activities, is normal and beneficial
part of life
All benefit socially and physically when play
begins at an early age
Studies have shown that physical activity on
average reduces seizure frequency and lead to
improved cardiovascular and psychological
health.
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Sports restriction may impact child from
psychosocial standpoint
Sedentary lifestyle pose greater health risks
than sports participation itself
Increased BMI, decreased aerobic endurance,
poorer self-esteem and higher levels of anxiety
and depression
Prior to Participation
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General precautions:
Following methods of conduct and play
Utilizing suitable protective equipment
Playing responsibly within the rules
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Special precautions for children with epilepsy:
Determine risk for injury and physical
impairments
Type and timing of seizure (GTC, atonic,
absence vs. simple partial)
Confirming adequate seizure control with
medications
Following medication levels and compliance
Increased vigilance about proper diet and rest
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What is adequate seizure control?
No consensus
Adequate control is largely individualized goal
Complete seizure freedom is every clinician’s
goal – but in some patients impractical
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Some require multiple medications to control
seizures which results in side effects (lethargy
and confusion)
Most patients are able to be controlled on 1
medication  encouraged to participate in
sports
ILAE recommends if child has been seizure
free > 1 year  most restrictions can be lifted
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Provided seizures are reasonably controlled,
most sports are acceptable to play
Some may require additional supervision
Adequate seizure control, close monitoring of
medication and preparation of family and
coaches
Aerobic Sports
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Aerobic sports (running, track and field or
stationary bike conditioning):
No specific risks if fluid intake and
electrolyte balance are maintained
Adequate preparation with diet
Can decrease seizure frequency, reduce
future health problems, improve body selfimage and self-esteem
Contact Sports
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Children with epilepsy should not be precluded
from contact sports (football, hockey,
basketball, martial arts)
Theoretically, trauma from contact sports
resulting in recurrent minor head injuries could
cause seizures or worsen epilepsy
Very few case reports support these notions
Contact Sports
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Many studies show no increased injury risk for
children with epilepsy who play contact sports
Boxing is exception and is prohibited in those
with epilepsy (AAN, AMA, and AAP)
Water Sports
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Swimming and water sports- excellent way to
improve cardiovascular health and maintain muscle
strength and tone
Direct visual supervision should always be present
Supervising person should have adequate training in
rescue and resuscitation
Avoid swimming in open water
Swimming should be avoided in those with frequent
seizures
Water Sports
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Boating with floatation device is ok
Scuba diving is prohibited
X
Sports from Heights
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Gymnastics involves increased risk due to
certain skills performed at greater heights
Ok for children with well-controlled seizures
and if observed by coaches aware of their
condition
Sports from Heights
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Some references do not recommend
gymnastics especially balance beam and
uneven bars
Having seizure during these events can result
in fall and cervical spine injury
Other references allow gymnastics with
reasonable precautions/ direct supervision
Sports from Heights
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Horseback riding and harnessed rock climbing
– only if seizures well controlled and with
person who can provide first aid and contact
emergency personnel
Hand-gliding, parachuting and free climbing
not recommended
Motor Sports
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Motor sports – some say minimum of 2 years
seizure freedom
Possibility for catastrophic injury
An accident at the speeds attained in motor
sports is danger to driver, other drivers and
spectators
Most feel that motor sports should be avoided
Summary
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Aerobic sports such as running track and
cross-country skiing – no special precautions
Contact and collision sports such as basketball
and football – usual precautions (e.g. helmet)
and direct supervision
Swimming – direct supervision by an
experienced swimmer/ “buddy” system
Summary
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Sports such as hand-gliding, scuba diving and
mountain climbing not recommend due to risk
of severe injury or death if seizure occurs
Boxing is prohibited since head trauma can
precipitate seizures
Conclusions
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Participation in sports and physical activity is
important way to maintain physical and
psychological health
Children with epilepsy should not be excluded
from participation in sports
More harm may be caused by discouraging
physical activity
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Sports involving heights and speeds are not
recommended
Majority of sports are safe and will potentially
reduce seizure frequency and improve quality
of life
References
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Howard et al. Epilepsy and Sports Participation. Current
Sports Medicine Reports 2004. 3:15-19.
Miele Vincent J.. Participation in Contact or Collision Sports
in Athletes With Epilepsy, Genetic Risk Factors, Structural
Brain Lesions, or History of Craniotomy. Neurosurg Focus.
2006;21(4).
Fountain NB, May AC. Epilepsy and athletics. Clin Sports
Med 2003;22(3)
Epilepsy and Sports Participation. Wyoming Epilepsy
Association.
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