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Seizure

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Other Names

  • Seizure Disorder
  • Epilepsy

Background

  • This page describes both known seizure disorders in athletes as well as new onset seizures
  • Definition of epilepsy: two or more unprovoked seizures more than 24 h apart in a child older than 1 month[1]

Epidemiology

  • Seizure disorder in the general population[2]
    • Incidence: approximately 50 per 100,000 persons per year
    • Prevalence: 5 to 10 per 1,000 persons in most areas
  • In pediatrics, 0.5-1% of children are affected
  • Prognosis is favorable, more than 70% will achieve good seizure control and eventually remission[3]

Pathophysiology

Health Implications

  • People with seizure disorders have long been restricted from certain sports and physical activities
    • Subsequently less fit and active then unaffected peers
  • Bjorholt et al found that people with seizure disorder are only half as active as their age matched peers[4]
    • They also found declines in aerobic capacity are accelerated in individuals with seizure disorder
  • Individuals with seizure disorder are more likely to abstain from physical exercise[5]
  • Wong et al compared individuals with seizure disorder to their siblings[6]
    • Teens with epilepsy were less active, had higher BMI, participated in fewer group sports
  • Most commonly cited reasons for not participating: lack of time, health problems, and fear of seizures[7]
    • In some cases, advised to avoid activities by family, physician(s)
  • Seizure disorder also has psychosocial implications
    • Increased absenteeism[8], decreased academic performance[9], lower self-esteem, loneliness, depression, anxiety, and behavioral problems
    • These issues appear to be related to peer acceptance, development of autonomy[10]
  • Physical activity has proven health benefits in individuals with seizure disorder
    • This includes a reduction in seizure frequency[11]
    • Proposed mechanisms include modulation of neurotransmitter systems including several seizure-inhibitory components such as adenosine, neurosteroids, gamma amino butyric acid a (GABA), and sensory inputs[12]

Sports Participation

  • Canadian Community Health Survey[13]
    • 12-month injury prevalence was not different among those people with epilepsy and the general population
    • Lower overall frequency of sport-related injury among persons with epilepsy
    • Three times higher rate of hospitalization following injury in this group which the suspected was due to a more cautious attitude among health care providers with seizure patients
  • Kirsch et al: cognitively normal children with epilepsy did not have a significantly increased rate of accidental injury in comparison with their nonepileptic friends[14]
  • Sahoo et al: contact sports with repetitive minor head injury fail to show any increase in seizures or to exacerbate seizure disorders[15]
  • McCory et al: Concussions with subsequent seizure activity did not lead to the development of epilepsy among 22 athletes[16]
  • Sport sports participation has been show to decrease seizure frequency rather than increase it, despite the stressors associated with physical activity and competition[12]
  • Nikken et al showed that a 4 week intensive exercise regimen lead to a slight but statistically insignificant decrease in seizure activity among individuals with uncontrolled seizure activity[17]
    • Participants also demonstrated improved aerobic capacity and fitness
  • Ramirez et al found a slightly higher injury rate among students with a history of seizure (4.5 per 1000 athlete exposures) when compared to students with no seizure history (1.6 per 1000 athlete exposures).[18]
    • None of the injuries were seizure related
    • Ramirez used a stricter definition counting any incident resulting in removal from play where as other studies typically define injury as restricted from sports participation for more than 1 day

Recommendations for Participation

  • Based upon AMA[19], AAP[20] recommendations
  • No restrictions:
    • Running
    • Cycling
    • Basketball
    • Baseball
    • Football
    • Soccer
    • Rugby
    • Ice Hockey
    • Field hockey
    • Judo
    • Other team sports
  • No restriction with supervision
    • All water sports (except scuba diving)
  • Absolute full restriction
    • Scuba Diving
    • Skydiving
    • Base jumping
    • Other airborne or freefall activities
  • Controversial
    • Gymnastics
    • Rock climbing

Risk Factors

Differential Diagnosis

Clinical Features

Evaluation

Classification

Management

Nonoperative

Operative

Rehab and Return to Play

Rehabilitation

Return to Play

Complications

See Also

References

  1. ↑ Shinnar S, Pellock JM. Update on the epidemiology and prognosis of pediatric epilepsy. J. Child Neurol. 2002; 17 (Suppl. 1): S4–17.
  2. ↑ Sander JW. The epidemiology of epilepsy revisited. Curr. Opin. Neurol. 2003; 16: 165–70.
  3. ↑ Fejerman N. Epilepsy in children and adolescents. Epilepsia. 2002; 43 (Suppl. 6): 44–6.
  4. ↑ Bjørholt PG, Nakken KO, Røhme K, et al.. Leisure time habits and physical fitness in adults with epilepsy. Epilepsia. 1990; 31: 83–7.
  5. ↑ Nakken KO. Physical exercise in outpatients with epilepsy. Epilepsia. 1999; 40: 643–51.
  6. ↑ Wong J, Wirrell E. Physical activity in children/teens with epilepsy compared with that in their siblings without epilepsy. Epilepsia. 2006; 47: 631–9.
  7. ↑ Arida RM, Scorza FA, de Albuquerque M, et al.. Evaluation of physical exercise habits in Brazilian patients with epilepsy. Epilepsy Behav. 2003; 4: 507–10.
  8. ↑ Serdari A, Tsalkidis A, Tripsianis G, et al.. Epilepsy impact on aspects of school life of children from different cultural populations in Thrace, Greece. Epilepsy Behav. 2009; 15: 344–50.
  9. ↑ McNelis AM, Dunn DW, Johnson CS, et al.. Academic performance in children with new-onset seizures and asthma: a prospective study. Epilepsy Behav. 2007; 10: 311–8.
  10. ↑ McEwan MJ, Espie CA, Metcalfe J, et al.. Quality of life and psychosocial development in adolescents with epilepsy: a qualitative investigation using focus group methods. Seizure. 2004; 13: 15–31.M
  11. ↑ Arida RM, Cavalheiro EA, da Silva AC, et al.. Physical activity and epilepsy: proven and predicted benefits. Sports Med. 2008; 38: 607–15.
  12. ↑ 12.0 12.1 Arida RM, Scorza FA, Terra VC, et al.. Physical exercise in epilepsy: what kind of stressor is it? Epilepsy Behav. 2009; 16: 381–7.
  13. ↑ Tellez-Zenteno JF, Hunter G, Wiebe S. Injuries in people with self-reported epilepsy: a population-based study. Epilepsia. 2008; 49: 954–61.
  14. ↑ Kirsch R, Wirrell E. Do cognitively normal children with epilepsy have a higher rate of injury than their nonepileptic peers? J. Child Neurol. 2001; 16: 100–4.
  15. ↑ Sahoo SK, Fountain NB. Epilepsy in football players and other land-based contact or collision sport athletes: when can they participate, and is there an increased risk? Curr. Sports Med. Rep. 2004; 3: 284–8.
  16. ↑ McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ. 1997; 314: 171–4.
  17. ↑ Nakken KO, Bjørholt PG, Johannessen SI, et al.. Effect of physical training on aerobic capacity, seizure occurrence, and serum level of antiepileptic drugs in adults with epilepsy. Epilepsia. 1990; 31: 88–94.
  18. ↑ Ramirez M, Yang J, Bourque L, et al.. Sports injuries to high school athletes with disabilities. Pediatrics. 2009; 123: 690–6.
  19. ↑ Corbitt RW, Cooper DL, Erickson DJ, et al.. Epileptics and contact sports [editorial]. JAMA. 1974; 229: 820–1.
  20. ↑ Sports and the child with epilepsy. Pediatrics. 1983; 72: 884–5.
Created by:
John Kiel on 14 June 2019 08:19:04
Authors:
Last edited:
30 January 2020 16:47:08
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