Exercise as it relates to Disease/Does intense physical exercise improve the seizure threshold in epileptics?

This is an analysis of the journal article "Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy" by Vancini.L. R. et.al. (2010)



What is the background of this research?
Epilepsy is the most common serious neurological condition. It affects approximately 1% of the global population (70 million people) (Perucca & Tomson, 2011). It is defined by when a person has multiple seizures. These seizures can be seen on an electroencephalogram (EEG) as an abnormal spikes of electrical discharge occurring in an area of the brain (Duncan et al., 2006). There are many different types of epilepsy that can be categorized depending on what the seizure looks like, where the seizure takes place in the brain, whether or not the person is unconscious or conscious (Duncan et al., 2006). It can currently be treated with a type of medication called an anti-epileptic medication (AED). The aim of the AED is to reduce the electrical discharge in the brain and therefore raise the seizure threshold (Perucca & Tomson, 2011). This research looks into if exercise could potentially temporally raise the seizure threshold in epileptics.

Where is the research from?
Institutes involved:
 * Department of Physiology, Federal University of São Paulo (UNIFESP), São Paulo (SP), Brazil
 * Federal University of Goiás (UFG), Jatoba Unit, Campus Jataí Jataí (GO), Brazil
 * Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo (SP), Brazil
 * Center for Technological Research, University of Mogi das Cruzes (UMC), São Paulo, Brazil
 * Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo (SP), Brazil

What kind of research was this?
This was a cross-sectional study. It involved a total of 38 subjects in looking at and comparing two groups: .
 * Control (19)- To be in this group the subject had to be healthy and no progressive neurological disorder, intellectual limitations, or have a history of cardiovascular, pulmonary, orthopedic, or endocrinological diseases ( Vancini.L. R. et.al., 2010)
 * Epilepsy (19)- To be in this group the subject had to have temporal lobe epilepsy and had to have been diagnosed with it for at least 2 years ( Vancini.L. R. et.al., 2010)

What did the research involve?
The researchers used people with temporal lobe epilepsy (TLE) as it is a very common form of focal epilepsy, which is the most common type of epilepsy (National Institute of Neurological Disorders and Stroke, 2015) and in order for the study to be standardized the participants had to have the same type of epilepsy.

The control group were recruited from the Federal University of Sao Paulo. The epilepsy group were gathered from neurology clinic. Initial contact was made via a telephone call, in which the nature of the study was outlined to subjects and consent was gained. Out of the 32 people who were contacted, only 19 agreed to participate in the study. This was perhaps out fear of having a seizure ( Vancini.L. R. et.al., 2010) .

The study involved comparing the epilepsy group against the control group in 3 main categories . . The data obtained from tests:
 * Habitual Physical Activity Questionnaire – A questionnaire was administered consisting of 16 questions across 3 areas: occupational physical activity, physical exercise in leisure time and leisure and locomotion activities ( Vancini.L. R. et.al., 2010)
 * Quality of Life in Epilepsy Inventory -31 - This survey was given to the epilepsy group and the control group. Only eighteen out of thirty-one of the questions given could be answered by the control group due to other questions only being applicable to the epilepsy group. This is a weakness in the study.
 * Cardiopulmonary exercise tests - This test was given to both the epilepsy and control groups. During the cardiopulmonary tests the subject were asked to exercise for as long as they felt could ( Vancini.L. R. et.al., 2010)
 * O2 uptake
 * CO2 production
 * Respiratory exchange rates
 * Minute ventilation
 * Respiratory rate
 * Ventilatory equivalents for O2 and CO2
 * Expired fractions of O2 and CO2
 * Heart rate (HR)
 * O2 pulse

The study also involved looking at and comparing the EEG of the epilepsy group during 3 periods: This test was only compared amongst the epilepsy group.
 * Rest (pre-exercise)
 * Exercise
 * Recovery (post-exercise)

What were the basic results?
Behavioural Measures Quality of Life in Epilepsy Inventory-31: The data collected from both groups showed that the epilepsy group scored substantially lower in emotional well being, cognitive function and global health status ( Vancini.L. R. et.al., 2010) . Habitual Physical Activity Questionnaire: The study showed that the control group had higher levels (>14.8%) of physical activity during leisure time compared to the epilepsy group ( Vancini.L. R. et.al., 2010) .

Physiological Evaluation Cardiopulmonary Test: There was no significant difference in the results of most physical assessments given. However, compared to the control group, the epilepsy group demonstrated a far lower anaerobic threshold (<16.1%). The control group recorded a higher VO2 max (>14.6%)than the epilepsy group ( Vancini.L. R. et.al., 2010) .

Electroencephalogram (EEG): The results showed that the number of epileptiform discharges (abnormal electrical activity) decreased by 82% between rest and exercise and 74% between rest and recovery ( Vancini.L. R. et.al., 2010)

Whilst this results shows a decrease it is not statistically a big one. Perhaps a larger sample size is need to get better results. The results gathered from the tests could have also been affected from from the different type of AED’s the participants were taking.

What conclusions can we take from this research?
The research shows that exercise is not a seizure inducing factor, which is contradictory to what many epileptics believe (Arida, M. et al., 2010). Because of this belief many epileptics choose to avoid exercise and because of this, general fitness can be lower and in turn quality of life may be affected. In-fact this research illustrates that maximal effort exercise can reduce the amount of abnormal electrical activity in the brain and therefore temporally raise a person’s seizure threshold ( Vancini.L. R. et.al., 2010) .

Practical advice
Awareness needs to be raised surrounding the benefits of exercise and epilepsy. It could potentially lead to better control in seizures, especially in those whose epilepsy is considered refractory (untreatable by medication). Not only could the exercise help with reducing seizure activity in the brain, but it is also good for overall well being and fitness. ( Vancini.L. R. et.al., 2010) People with epilepsy should follow the recommended daily exercise guidelines and exercise at least 30mins 5x a week ( Department of Health, 2014) Before taking on any new exercise regime always consult a GP or specialist.

Further information/resources
For further information:
 * About epilepsy:http://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy
 * Epilepsy and exercising https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-and-exercise
 * Staying safe with sport & epilepsy: http://www.epilepsy.com/get-help/staying-safe/safety-exercise-and-sports

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