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Other Names

  • Seizure Disorder
  • Epilepsy


  • 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]


  • 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]


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






Rehab and Return to Play


Return to Play


See Also


  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
Last edited:
30 January 2020 16:47:08