This blog is created by James Balutan for Dr. Greg Wells’ KPE 465 course. This blog focuses on exercise and its relationship to children with epilepsy. This blog examines the pathophysiology and the exercise recommendations for children with epilepsy. Overall, this blog will further explore how physical activity will benefit children with epilepsy.
Pathophysiology of Epilepsy and Exercise (Part 1)
Written by: James Balutan
Learning Objectives
This report will provide insight on the relationship between exercise and children with epilepsy. I will closely examine the benefits that are introduced with exercise, and the risks that are present with lack of exercise among epileptic children. This report will help in understanding the pathophysiological mechanisms of exercise and epilepsy.
Summary & Overview
Epilepsy is one of the most common neurological disorders among children, affecting more than 1% of the population. Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. It presents a barrier that deters children in participating in physical activity. The lack of physical activity among epileptic children causes many psychological and physical complications. The information presented in this report gives us a greater understanding of the mechanisms that play among exercise and children with epilepsy. It examines the barriers and benefits of physical activity, and how exercise can be used as an effective medicine.
Commentary
The data I have gathered for this report has significant amount of information about the effects of physical activity among children with epilepsy. I believe that the articles that I have used in this report provided great arguments and supported them with reliable evidence. The articles I have used all have similar perspective and viewpoint in terms of importance of physical activity in epileptic children. All articles emphasized the importance of a proper exercise program and if constructed properly, can be used as a medicine to treat epilepsy. The articles provide the reader with proper background information to help increase understanding of the mechanisms that is present with epilepsy. Although I have found great articles that provide useful information in understanding the correlation between epilepsy and exercise, I do believe that the scientific community is in need of more research in the subject. There were limited amounts of research in terms of physical activity and exercise. The size of research is further minimized once it is focused on children and epilepsy. There is also a lack of experimental research in the subject. Most articles I have found were reviews and overview on the subject. The only experimental article I have found was by Wong & Wirrell, which compared exercise among children with epilepsy and their siblings. Considering epilepsy is one of the most common neurological disorders in children, I believe that we must focus on generating more research to further improve our knowledge on the subject for the future.
Exercise and Seizure
Epilepsy is one of the most common neurological disorders in children, affecting more than 1% of the population. Physical activity levels among children with epilepsy have been reported to be lower, than those of normal children. Results from a study by Wong & Wirrell (2006) show that children with epilepsy were less likely to exercise compared to their siblings without epilepsy. Higher seizure frequency led to lower total participation. Factors of exercise that may initiate seizures are fatigue, emotional stress, fever, heat, humidity, and sleep deprivation. Stress is one of the many triggers that can initiate a seizure; therefore by performing exhaustive exercises, epileptic children disrupt homeostasis and risk an attack. However, there are only a few extremely rare cases of exercise-induced seizures, at which occurred at extremely intense vigorous physical activity (Howard, Radloff, & Sevier, 2004). The avoidance of physical activity among children with epilepsy is due to the concern of injury during participation. Parents, coaches, and instructors are often scared of the children experiencing a seizure during play, which leads to restriction of participation. Epileptic children were also deterred by some epileptic medicine that minimizes physical abilities and make them appear less physically adept to their peers. There remains a stigma associated with epilepsy that has prevented involvement in sports and recreational activities for years (Howard, Radloff, & Sevier, 2004). The lack of exercise and physical activity among children with epilepsy leads to multiple risk factors, both physically and psychologically. Epileptic children often develop hypertension, high BMI, and diabetes due to low energy expenditure (Arida, Scorza, Gomes da Silva, Schachter, & Cavalheiro, 2010). Children with epilepsy also show lower self-esteem and self-confidence. Children with epilepsy have higher prevalence of depression and anxiety. The lack of participation in group sports activities create an environment of social isolation for teens and children with epilepsy (Wong & Wirrell, 2006). The risks of injury during exercise for epileptic children are minimal compared to the risks that come with being physically inactive.
Participation in physical activity is a great way for epileptic children to maintain and improve physical and psychological health. Physical activity provides children with epilepsy with tremendous amounts of benefits that lead to an improved quality of life. Exercise reduces seizure frequency, severity and improves seizure control for individuals with epilepsy (Eom, Kyung Lee, Park, Jeon, Kang, Lee, & Kim, 2014). Exercise may have an anticonvulsant effect on individuals with epilepsy as it releases B-endorphins, which inhibit epileptic discharges (Arida et al., 2010). Physical capabilities such as increased maximal aerobic capacity, increased work capacity, and reduced heart rate also occur among children with epilepsy with participation in physical activity. Exercise also creates opportunities for children to create social connections and interactions among other
children, creating a sense of belonging (Wong & Wirrell, 2006). Physical activity provides children with an environment that create social support that reduces stress. Reports show that epileptic children who were active showed significantly lower levels of depression, anxiety, as well as better psychosocial adjustment (Arida et al., 2010). Exercise among epileptic children also reduces body fat percentage, which can further encourage physical activity. Exercise also shows positive correlation with increased bone density which is essential as Children with epilepsy often take antiepileptic drugs which leads to bone loss (Eom et al., 2014). Those with epilepsy should not be excluded from participation in sports for fear of causing injury or inducing seizures. Discouraging physical activity, which in turn prevents its many benefits, may cause more harm.
Exercise as Medicine (Part 2)
Written by: James Balutan
Learning Objectives
Physical Activity can act as medicine for children with epilepsy. It provides multiple psychological, social, and physical benefits. Howe
ver, physical activity programs for children with epilepsy must be constructed properly to maximize development and ensure safety. This report will outline the recommended physical activity program specifications for children with epilepsy.
Summary & Overview
Creating a properly structured exercise program is essential for children with epilepsy. This report examines how different types of activities can physiologically affect epileptic children. The exercise recommendations provided in this report should be incorporated into clinical practice to increase safety and reduce chances of a seizure attack during exercise. These recommendations will provide epileptic children will provide children with a healthy lifestyle, while maintaining all the precautions of epilepsy. This report provides information to further expand our knowledge on the correlations between physical activity and epilepsy.
Interventions & Recommendations
Promoting physical activity in children is a challenge that should be looked upon in multiple perspectives. Proper program construction and supervision is essential in encouraging children with epilepsy to participate in physical activity. Physical Activity if used properly, can act as a natural medicine for children with chronic diseases. Exercise programs for children with epilepsy must examine the risks and benefits of participation, and must take proper precaution and preparation (American Academy of Pediatrics, 1983). Young athletes must be taught that there is a risk of injury and he or she should be prepared to impose voluntary restrictions on PA depending on the nature and frequency of seizures. Parents, coaches, instructors, etc. must always be prepared for any epileptic events to occur. Proper medical management, good seizure control knowledge, and close super
vision is essential (American Academy of Pediatrics, 1983). Physical activity professionals should be aware of the intensity of the program and how the variables can affect a child with epilepsy. Some factors in exercise programs, such as fatigue, the stress of competition, hypoxia, hyperthermia, and hypoglycemia, may affect the epileptic disorder (Arida, Scorza, Gomes da Silva, Schachter, & Cavalheiro, 2010). Therefore, exercise programs should stay within low to moderate intensity levels, as vigorous physical activity has higher chances of inducing an attack (Howard, Radloff, & Sevier, 2004).
Majority of sports and exercise are safe for epileptics if supported with close monitoring of medications, and preparation of family, coaches, and trainers (Howard, Radloff, & Sevier, 2004). Epileptics should be as active as their peers, and exercise programs must promote participation and increase in confidence. Aerobic sports such as running, basketball, etc. present no specific risk as long as the children are provided with proper electrolytes and diet (Howard, Radloff, & Sevier, 2004). Aerobic exercise should focus mainly on using the larger muscle groups with goals to increase VO2max, work rate, and endurance. An intensity goal should be 60% to 80% of their peak work rate for 3 to 4 days a week with sessions lasting from 20 to 30 minutes. Intensity and duration of the aerobic workout program must progress as the individual gains aerobic capacity and increase fitness (Eom et al., 2014).
Resistance exercise is also a good option for physical activity programs for children with epilepsy. It builds muscle and
prevents atrophy (Howard, Radloff, & Sevier, 2004). Resistance training also leads to increased confidence as their physical capabilities increase. Programs should incorporate resistance training with low resistance and high repetitions, and create reliable exercise progression throughout the program (Wong & Wirrell, 2006).
If seizures are properly controlled, epileptic children are encouraged to participate in most types of sports. As stated earlier, individual precautions must be taken for different sports however; children with epilepsy are still encouraged to participate in various types of sports (Howard, Radloff, & Sevier, 2004). It is important that the individual with epilepsy feel normal and reinforce a positive self-image. One stigma that exists is that children with epilepsy should not participate in contact or collision sports. However, the presence or absence of contact and collision should not define an epileptic’s ability to participate (Eom et al., 2014). They should be encouraged as long as there is proper supervision and the risks and benefits are properly analyzed. Water sports also offer many benefits for epileptic children. It is easy on the joints and it is enjoyable. However, like all the sports, proper supervision is important to ensure safety. Patients should avoid swimming in open or murky water, and should wear a certified personal flotation device while in the water. Sports that are not encouraged for epileptic children are those that occur in high altitude such as rock climbing, and those that is composed of speed and/or isolation during competition such as mountain biking (Howard, Radloff, & Sevier, 2004). Being isolated can result into delayed help for epileptic children.
These exercise programs for children with epilepsy relies on proper structure to ensure a fun and safe environment that promotes development. Programs must provide a group setting that gives social support and interaction. Relationship between trainer and participants is extremely important and has the ability to have therapeutic effects on the children (Eom et al., 2014). Those with epilepsy should not be excluded from participation in sports for fear of causing injury or inducing seizures. Discouraging physical activity, which in turn prevents its many benefits, may cause more harm.
References
References
Arida, R. M., Scorza, F. A., da Silva, S. G., Schachter, S. C., & Cavalheiro, E. A. (2010). The potential role of physical exercise in the treatment of epilepsy. Epilepsy and Behavior, 17(4), 432-435. doi:10.1016/j.yebeh.2010.01.013
Eom, S., Lee, M. K., Park, J., & Jeon, J. Y. (2014). The impact of an exercise therapy on psychosocial health of children with benign epilepsy: A pilot study. Epilepsy and Behavior, 37, 151.
Howard, G. M., Radloff, M., & Sevier, T. L. (2004). Epilepsy and sports participation. Current Sports Medicine Reports, 3(1), 15-19.
Strupp, M. (2010). News on treatment: From antiepileptics in childhood absence epilepsy to improvement of falls in Parkinson’s disease by deep brain stimulation. Journal of Neurology, 257(4), 683-685. doi:10.1007/s00415-010-5541-4
Wong, J., & Wirrell, E. (2006). Physical activity in Children/Teens with epilepsy compared with that in their siblings without epilepsy. Epilepsia, 47(3), 631-639. doi:10.1111/j.1528-1167.2006.00478.x
Exercise for children with Epilepsy 