Exercise as it relates to Disease/Responses towards exhaustive acute physical exercise in participants with temporal lobe epilepsy

This wikibook page is a critique of Vancini et al's"Cardiorespiratory and electroencephalographic responses to exhaustive acute physical exercise in people with temporal lobe epilepsy".

What is the background to this research?
Epilepsy is a neuronal condition that affects 2% of the population. Temporal Lobe Epilepsy (TLE) is the most common form of partial epilepsy, affecting an estimated 40% of patients. Epilepsy presents with psychiatric comorbidities such as anxiety and depression, posing a significant issue for quality of life. Previous research suggested that physical exercise of any kind was to be prohibited in patients with Epilepsy. However, studies in both humans and animals reported reduced seizures after physical exercise.

Where is the research from?
With recent findings, research into this very real issue has now shifted towards the positive effects between TLE and exercise to highlight if exercise can reduce seizure susceptibility, improvement in the individual's quality of life and reduce levels of anxiety and depression.

One of the major researchers in this study is Ricardo Mario Arida who has numerous articles supporting exercise as a positive treatment method. Some of Arida's previous studies and findings include;

What kind of research was this?
A Cohort Study design was implemented to demonstrate the behavior between participants with TLE compared with a control group.

What did the research involve?
19 Epilepsy patients from a Neuronal Clinic who had been diagnosed with TLE for at least 2 years and 19 matching gender, age, and socioeconomic profile control patients were recruited from the Federal University of São Paulo, Brazil. The study aimed to determine if intensive exercise alters seizure susceptibility, quality of life and level of habitual physical activity in individuals with TLE. All participants gave informed consent forms prior to participating.

All participants completed the "Habitual Physical Activity Questionnaire" and the "Quality of Life in Epilepsy Inventory-31" (QOLIE-31). The "Quality of life in epilepsy" was completed by the TLE group only and was verified with the QOLIE-31.

A physical examination (10 mins at rest) was conducted, followed by an electrocardiogram (EEG) at rest and during effort in both groups. After the EEG was complete a cardiopulmonary exercise test (CPET) was used to gather anaerobic threshold (AT), respiratory compensation point (RCP) and VO2max.

In the CPET, participants in both groups were instructed to cycle on an air-brake ergometer for 5 minutes warm up (between 10-25W), followed by 10-25 W increases every 2 minutes until exhaustion. RPE was recorded at each stage of the test using the CR-10 scale. The participants were encouraged to ride to exhaustion.

What were the basic results?
Physical activity during leisure time was 14.8% greater in the control group than the epilepsy group. The epilepsy group scored significantly lower on the Emotional Well-Being (17.3%), Cognitive Function (32.4%), and Global Health Status (26.8%) of the QOLIE-31 compared to the control group.

Compared with the control, the epilepsy group had significantly lower AT (16.1%) expressed as a function of VO 2. No person in the epilepsy group had a seizure during the rest state, the CPET, or the recovery period.

What conclusions can we take from this research?
Physical exercise is not considered a seizure-inducing factor. This is supported by the fact that no seizures were reported throughout the study. The individuals with TLE had seizure levels of physical activity during leisure time and worse perceptions of quality of life compared with healthy subjects. This is potentially due to chronic inactivity due to the safety of seizure-inducing activity.

The lack of significant differences in physiological variables during exercise suggests that epilepsy may not pose physiological limitations. Therefore it can be suggested that TLE may not have a negative impact on the functional capacity of the muscular, cardiovascular, and respiratory systems.

Practical advice
For individuals with TLE, and epilepsy in general, researchers should aim to break the stigma of epilepsy and exercise. Although the most commonly used therapeutic approach to control seizures is pharmacological, researchers should endeavor to moderate the use of pharmacological approaches if exercise can provide advantages to less serious cases of epilepsy.

Ideally, further studies with more participants from a broader range of ethnic backgrounds could improve research. However, due to the number of high-risk seizure patients, future research should take this into consideration. The type of study could also be manipulated e.g. a longitudinal study to identify if physical exercise is a long-term treatment method.

Further information/resources
1. The psychosocial impact of exercising with epilepsy: https://ac-els-cdn-com.ezproxy.canberra.edu.au/S1525505016301408/1-s2.0-S1525505016301408-main.pdf?_tid=ea287d38-62a3-42e7-b83f-98b9b2bb1ad5&acdnat=1537180034_11663db9241d5ffebc37fd3b5a44c2c4 2. Diet, exercise, sleep, sexual activity, and perceived stress in people with epilepsy in NE Thailand: https://www-sciencedirect-com.ezproxy.canberra.edu.au/science/article/pii/S1525505015000621

3. Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy: https://onlinelibrary-wiley-com.ezproxy.canberra.edu.au/doi/full/10.1111/epi.13261