Physical exercise in epilepsy

1. Physical exercise in epilepsy Sport has now acquired a truly important presence in our lives. Its magic attracts us, both spectators and practitioners. This attraction exists because in the sport we throw much enthusiasm and illusions and even some frustration, that is, part of our lives. So to speak, the sport is a representation of the daily life, although in form of game. On the other hand, we have unequivocal evidence of the beneficial effect on different organ systems, of their help in the prevention of different diseases, especially those of cardiovascular type and as a contributor to the pharmacological and non-pharmacological treatment of others. This is why the concept of exercise prescription has begun to prevail, especially in the medical field, as a process by which a person, healthy or sick, it is recommended an individualized physical activity regimen suited to their needs, unlike the classic concept of prescribing or prescribing a drug, a treatment or a procedure. The treatment of the epileptic patient is multidisciplinary and aims to improve the quality of life of these patients and their psychosocial and work situation. Sport is going to be an instrument of enormous importance to achieve this goal. EFFECT OF PHYSICAL EXERCISE ON EPILEPSY Regular physical activity is beneficial for all age groups and different types of diseases, including in epilepsy, so when we introduce an exercise plan for the epileptic patient we can help improve their physical condition, their self-esteem and confidence. It is generally thought that adults and children with epilepsy should not participate in sports and yet, with appropriate precautions, many of them may participate in different types of sports. The contribution of physical exercise to the general well-being of the organism is widely recognized by both the scientific community and the population in general. Numerous studies have revealed the relationship between the practice of physical exercise and the reduction of the presence of coronary diseases, its effectiveness as a method of weight control or in the prevention and treatment of back pain and in the improvement of health mental, to name a few of them 7 .

2. More than a decade ago, Gotze et al studied the effect of exercise on electroencephalogram (EEG) and blood biochemical profiles of epileptics. These authors observed that aerobic exercise on a treadmill did not produce convulsive episodes. In fact, the typical convulsive type discharges observed at rest or with voluntary hyperventilation disappeared during the exercise and in the periods following the same. From these studies the conclusion was drawn that physical exercise raised the seizure threshold. On the other hand, Eriksen et al found that epileptic patients, after a 15-week exercise program, had a reduction in cholesterol levels and an increase in maximal oxygen consumption. Participants who underwent this training program reduced their muscle aches, sleep problems, fatigue and the frequency of their epileptic seizures. Further studies have found that the majority of patients performing regular exercise have a decrease in epileptiform discharges in the EEG. For example, a study of women with drug-resistant epileptic seizures and an average of 2.9 per week resulted in a significant decrease in epileptiform activity through the EEG, with a regular exercise program. Another study in Norway with 44 epileptic patients (defined as having had a monthly epileptic seizure in the year prior to the study) showed that when they exercised they felt better and maintained better control of their seizures during and after the exercise of a regular exercise program 6,9,10. These patients maintained a very sedentary lifestyle with low social contact and their maximum oxygen consumption was 75-80%, lower than recommended for their weight, height, age and sex. Twenty-one of them underwent a four-week, 45-minute daily physical epilepsy training program for six days a week, and a significant increase (19%) in maximal oxygen uptake and improved psychological status was observed of social contact. This regular physical training did not significantly modify either the mean frequency of epileptic seizures or the concentration in the blood of antiepileptic drugs. What there is no doubt is that physical exercise has multiple psychological benefits, reducing stress and improving self-esteem and depression. Why the American Academy of Sports Medicine and Pediatrics have opted for the benefits of participation in sports epileptics, against the risks inherent in any sport.

3. The sport, in any of its manifestations, has a very broad social dimension. In this sense, sport has, among its most constructive qualities, its capacity for integration. Children and adolescents with epilepsy and those who are acting on them, will have difficulty integrating into their social group and into the practice of physical exercise. Factors that may influence the occurrence of epileptic seizures must be taken to the correct extent. Fatigue, hypoxia and hypoglycemia can influence, however, a regularly performed physical exercise will rarely facilitate the appearance of these factors. This is how Frucht et al carried out a study of the predisposing factors in 400 epileptics and only two of them showed that physical exertion was a trigger for seizures. Only two retrospective reports show an increase in epileptiform discharges in the EEG after exercise in a probable relationship with a decrease in pH; however, more conclusive studies are needed. Another factor that has always been taken into account is hyperventilation, since in the laboratory it has been seen that can cause epileptiform discharges in the EEG and even crisis, especially absence type. However, hyperventilation that occurs during sports is a compensatory homeostatic mechanism and is not a crisis facilitator. In reality, crises decrease during and after physical activity. It has been observed that few crises occur during sports physical activity compared to periods of rest. In studies conducted by Horyd et al and Nakken et al in children during exercise tests performed with ergometry, they observed that epileptiform discharges decreased within 10 minutes of starting exercise 13. The reasons for this are unknown and the theories in this regard are several, from sensory inhibitory effects by increased attention and monitoring during the performance of the sport with changes in the targeting of the brain, decreases in carbon dioxide levels, decrease in emotional tension, etc. PREVIOUS EVALUATION FOR EXERCISING EPILÉPTICOS In the last 10-20 years the concept of "wellness" or "quality of life" has grown and within it has been included physical activity because it influences the individual making him feel good, improving his health, his appearance and his capacity

4. physical and relaxation and modifying the aging curves in many mental and physical aspects. An examination prior to performing physical exercises to get in shape is necessary because: 1) It assists in the diagnosis of diseases in symptomatic or asymptomatic individuals and determines the medical contraindications for the practice of certain sports. 2) It evaluates the cardiovascular and pulmonary capacity, as well as the muscular resistance of the individual. 3) Evaluates the safety of training and enables the development of a healthy and effective exercise prescription. 4) Evaluate the effectiveness of the interventions. 5) It follows the process of adaptation and serves as the basis for the prescription of training. The minimum sports medical examination that is necessary to perform an epileptic patient who is going to undergo a program of physical exercise will be the following: a medical-sport history with a history of both previous sports activities and past and present epileptic seizures and maintained treatment , a detailed physical examination, a 12-lead electrocardiogram, maximal or submaximal exertion test (depending on the level of professionalization of the athlete) (fig.1) monitored electrocardiographically and with blood pressure control for each step of blood effort and analytical and urine