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Can people with epilepsy enjoy sports?
Epilepsy Research (2012) 98, 94—95
journal homepage: www.elsevier.com/locate/epilepsyres
LETTER TO THE EDITOR KEYWORDS Epilepsy; Sports; Seizure, Physical activity; Exercise
Can people with epilepsy enjoy sports? Epilepsy is a chronic neurological condition characterized by recurrent unprovoked seizures. Approximately 3% of people in the general population will have epilepsy at some point in their life (Chang and Lowenstein, 2003). The impact of epilepsy on a person’s life is multidimensional and seizures have a significant impact on multiple domains of quality of life, with a particularly strong effect on physical role functioning (Leidy et al., 1999). Participating in physical exercise programs has significant benefits, including treating, preventing, and reducing risk factors for conditions such as diabetes, hypertension, coronary heart disease, obesity and osteoarthritis (Haskell et al., 2007). Exercise can also counteract the effects of some antiepileptic drugs that cause bone mineral density loss (Elliott et al., 2006). It is interesting to note that although patients with other chronic disorders have been encouraged to take part in sporting activities as a part of their rehabilitation, people with epilepsy are commonly excluded from physical activities because of fear, overprotection or ignorance. Other factors such as low self-esteem, depression, and anxiety are considerable barriers to an active life. Another obstacle for some persons with epilepsy who wish to participate in physical activities is the misperception that exercise provokes seizures and also makes them prone to injuries (Roth et al., 1994). In fact, available evidence suggests that physical activity can decrease seizure frequency and severity, as well as lead to improved cardiovascular and psychological health in people with epilepsy (Nakken et al., 1990; Eriksen et al., 1994; McAuley et al., 2001). Animal studies have also been performed to clarify the mechanisms by which physical exercise can induce positive effects in epilepsy (Arida et al., 2009). Considering the potentially beneficial effects of exercise in people with epilepsy, health professionals and sports instructors might actively encourage them to participate in sports and become more active. To this purpose, in
2009, the International League against Epilepsy (ILAE) and UEFA (European Football Association) co-organized a football event coordinated by Michel Platini, President of UEFA. This event preceded the opening of the 28th International Epilepsy Congress in Budapest, the congress in which ILAE celebrated its first 100 years of existence. It took place in Sweden on Friday June 26th, just before the opening of the two semi-final games of the UEFA Under-21 championship. Professors Alexis Arzimanoglou (France, President of the French League against Epilepsy), Michel Baulac (France, President of the European Commission of ILAE), Solomon L. Moshé (USA, Secretary General and President of the ILAE), Emilio Perucca (Italy, Vice-president of ILAE), and Torbjorn Tomson (Sweden, President of the Swedish Chapter of ILAE) accompanied the players to Sweden. Two short football matches took place in Göteborg and in Helsingborg with teams made up by players with epilepsy and former professional football players from many European countries). For more information see (http://www.ilaeepilepsy.org/visitors/Documents/PRESSBOOKILAEUEFADEF.pdf). This event was of great worth since football is one example of how sports can help our society to understand the issues surrounding persons with epilepsy including the reduction of discrimination and social stigma. Indeed, football is the most popular sport in the world and it is an important vehicle for the dissemination of influential messages to the public opinion worldwide. In a survey, that assessed the degree of participation in physical activities among Brazilian persons with epilepsy, reported that football is the most popular sport (Arida et al., 2003). Nevertheless, we have to bear in mind the Brazilian tradition in this sport. Other sport activities or different popular sports could also be of influential strategy to raise public awareness concerned this subject. Not only team sports but also individual sports can impact on disseminating information about sports participation in epilepsy. In this regard, several top level athletes with epilepsy may also serve as models of the positive effects of exercise in epilepsy. Considering the stigma and discrimination which still surround the disease, many athletes have not publicly revealed their condition. Nevertheless, there are important exceptions and examples include Marion Clignet, a top level competitive cyclist who was twice silver medalist at the Olympic Games (in 1996 in Atlanta, Georgia, USA, and in 2000 in Sydney, Australia), Chanda Gunn, an American ice hockey player (bronze medal at the 2006 Winter Olympics),
0920-1211/$ — see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.eplepsyres.2011.07.001
Can people with epilepsy enjoy sports? Salvatore Antibo (who won both the 5000 and 10,000 m races in the European Track and Field championship in Split in 2000 and was a silver medalist in the 10,000 m in the 1968 Olympic Games in Tokyo) and Jason Snelling, currently a running back for the Atlanta Falcons, among others. The present ILAE Executive Committee has defined a set of clear priorities for the 4 year term of office including education, global development of epilepsy care, and translational research. Within education, one of the key priorities is to highlight among epileptologists the positive aspects of physical activity in individuals with epilepsy. Accordingly, in all editions of the Latin-American Summers Schools on Epilepsy (LASSE), a landmark event that completely changed the outlook of epileptology in Latin America, the beneficial effects of physical activity in people with epilepsy was intensively discussed between students and tutors. The ILAE has also formed a task force to evaluate and establish new strategies (research directions, social, cultural and educational efforts) to disseminate information about sports participation in people with epilepsy What is the main aim of all our efforts? Considering that insufficient participation of people with epilepsy in sports activities or physical exercise programs is largely due to inadequate knowledge, it would be reasonable to educate physicians, health authorities, social workers, and sports instructors about the benefit of these activities for people with epilepsy. Events and testimonials such as those cited above can have a great impact on mass media, and emphasize the capacity of people with epilepsy to live a normal life and to engage in sports activities.
References Arida, R.M., Scorza, F.A., Albuquerque, M., Cysneiros, R.M., de Oliveira, R.J., Cavalheiro, E.A., 2003. Evaluation of physical exercise habits in Brazilian patients with epilepsy. Epilepsy Behav. 4, 507—510. Arida, R.M., Scorza, F.A., Scorza, C.A., Cavalheiro, E.A., 2009. Is physical activity beneficial for recovery in temporal lobe epilepsy? Evidences from animal studies. Neurosci. Biobehav. Rev. 33, 422—431, http://www.ilaeepilepsy.org/visitors/Documents/PRESSBOOKILAE-UEFADEF.pdf. Chang, B.S., Lowenstein, D.H., 2003. Epilepsy N. Engl. J. Med 349, 1257—1266. Elliott, J.O., Jacobson, M.P., Seals, B.F., 2006. Self-efficacy, knowledge, health beliefs, quality of life, and stigma in relation to osteoprotective behaviors in epilepsy. Epilepsy Behav. 9, 478—491. Eriksen, H.R., Ellertsen, B., Gronningsaeter, H., Nakken, K.O., Løyning, Y., Ursin, H., 1994. Physical exercise in women with intractable epilepsy. Epilepsia 35, 1256—1264.
95 Haskell, W.L., Lee, I.M., Pate, R.R., Powel, K.E., Blai, S.N., Franklin, B.A., Macera, C.A., Heath, G.W., Thompson, P.D., Bauman, A., 2007. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39, 1423—1434. Leidy, N.K., Elixhauser, A., Vickrey, B., Means, E., Willian, M.K., 1999. Seizure frequency and the health related quality of life of adults with epilepsy. Neurology 53, 162—166. McAuley, J.W., Long, L., Heise, J., Kirby, T., Buckworth, J., Pitt, C., Lehman, K.J., Moore, J.L., Reeves, A.L., 2001. A prospective evaluation of the effects of a 12-week outpatient exercise program on clinical and behavioral outcomes in patients with epilepsy. Epilepsy Behav. 2, 592—600. Nakken, K.O., Bjorholt, P.G., Johannessen, S.I., Løyning, T., Lind, E., 1990. Effect of physical training on aerobic capacity, seizure occurrence, and serum level of antiepileptic drugs in adults with epilepsy. Epilepsia 31, 88—94. Roth, D.L., Goode, K.T., Williams, V.L., Faught, E., 1994. Physical exercise, stressful life experience, and depression in adults with epilepsy. Epilepsia 35, 1248—1255.
Ricardo M. Arida ∗ Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 862, Ed. Ciências Biomédicas, 5◦ andar. Vila Clementino, 04023-900 São Paulo (SP), Brazil Fulvio A. Scorza Esper A. Cavalheiro Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil Emilio Perucca Department of Internal Medicine and National Institute of Neurology, University of Pavia, Pavia, Italy Solomon L. Moshé Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA ∗
Corresponding author. Tel.: +55 11 55764513; fax: +55 11 55739304. E-mail address: [email protected] (R.M. Arida) 27 June 2011 3 July 2011 Available online 22 July 2011
journal homepage: www.elsevier.com/locate/epilepsyres
LETTER TO THE EDITOR KEYWORDS Epilepsy; Sports; Seizure, Physical activity; Exercise
Can people with epilepsy enjoy sports? Epilepsy is a chronic neurological condition characterized by recurrent unprovoked seizures. Approximately 3% of people in the general population will have epilepsy at some point in their life (Chang and Lowenstein, 2003). The impact of epilepsy on a person’s life is multidimensional and seizures have a significant impact on multiple domains of quality of life, with a particularly strong effect on physical role functioning (Leidy et al., 1999). Participating in physical exercise programs has significant benefits, including treating, preventing, and reducing risk factors for conditions such as diabetes, hypertension, coronary heart disease, obesity and osteoarthritis (Haskell et al., 2007). Exercise can also counteract the effects of some antiepileptic drugs that cause bone mineral density loss (Elliott et al., 2006). It is interesting to note that although patients with other chronic disorders have been encouraged to take part in sporting activities as a part of their rehabilitation, people with epilepsy are commonly excluded from physical activities because of fear, overprotection or ignorance. Other factors such as low self-esteem, depression, and anxiety are considerable barriers to an active life. Another obstacle for some persons with epilepsy who wish to participate in physical activities is the misperception that exercise provokes seizures and also makes them prone to injuries (Roth et al., 1994). In fact, available evidence suggests that physical activity can decrease seizure frequency and severity, as well as lead to improved cardiovascular and psychological health in people with epilepsy (Nakken et al., 1990; Eriksen et al., 1994; McAuley et al., 2001). Animal studies have also been performed to clarify the mechanisms by which physical exercise can induce positive effects in epilepsy (Arida et al., 2009). Considering the potentially beneficial effects of exercise in people with epilepsy, health professionals and sports instructors might actively encourage them to participate in sports and become more active. To this purpose, in
2009, the International League against Epilepsy (ILAE) and UEFA (European Football Association) co-organized a football event coordinated by Michel Platini, President of UEFA. This event preceded the opening of the 28th International Epilepsy Congress in Budapest, the congress in which ILAE celebrated its first 100 years of existence. It took place in Sweden on Friday June 26th, just before the opening of the two semi-final games of the UEFA Under-21 championship. Professors Alexis Arzimanoglou (France, President of the French League against Epilepsy), Michel Baulac (France, President of the European Commission of ILAE), Solomon L. Moshé (USA, Secretary General and President of the ILAE), Emilio Perucca (Italy, Vice-president of ILAE), and Torbjorn Tomson (Sweden, President of the Swedish Chapter of ILAE) accompanied the players to Sweden. Two short football matches took place in Göteborg and in Helsingborg with teams made up by players with epilepsy and former professional football players from many European countries). For more information see (http://www.ilaeepilepsy.org/visitors/Documents/PRESSBOOKILAEUEFADEF.pdf). This event was of great worth since football is one example of how sports can help our society to understand the issues surrounding persons with epilepsy including the reduction of discrimination and social stigma. Indeed, football is the most popular sport in the world and it is an important vehicle for the dissemination of influential messages to the public opinion worldwide. In a survey, that assessed the degree of participation in physical activities among Brazilian persons with epilepsy, reported that football is the most popular sport (Arida et al., 2003). Nevertheless, we have to bear in mind the Brazilian tradition in this sport. Other sport activities or different popular sports could also be of influential strategy to raise public awareness concerned this subject. Not only team sports but also individual sports can impact on disseminating information about sports participation in epilepsy. In this regard, several top level athletes with epilepsy may also serve as models of the positive effects of exercise in epilepsy. Considering the stigma and discrimination which still surround the disease, many athletes have not publicly revealed their condition. Nevertheless, there are important exceptions and examples include Marion Clignet, a top level competitive cyclist who was twice silver medalist at the Olympic Games (in 1996 in Atlanta, Georgia, USA, and in 2000 in Sydney, Australia), Chanda Gunn, an American ice hockey player (bronze medal at the 2006 Winter Olympics),
0920-1211/$ — see front matter © 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.eplepsyres.2011.07.001
Can people with epilepsy enjoy sports? Salvatore Antibo (who won both the 5000 and 10,000 m races in the European Track and Field championship in Split in 2000 and was a silver medalist in the 10,000 m in the 1968 Olympic Games in Tokyo) and Jason Snelling, currently a running back for the Atlanta Falcons, among others. The present ILAE Executive Committee has defined a set of clear priorities for the 4 year term of office including education, global development of epilepsy care, and translational research. Within education, one of the key priorities is to highlight among epileptologists the positive aspects of physical activity in individuals with epilepsy. Accordingly, in all editions of the Latin-American Summers Schools on Epilepsy (LASSE), a landmark event that completely changed the outlook of epileptology in Latin America, the beneficial effects of physical activity in people with epilepsy was intensively discussed between students and tutors. The ILAE has also formed a task force to evaluate and establish new strategies (research directions, social, cultural and educational efforts) to disseminate information about sports participation in people with epilepsy What is the main aim of all our efforts? Considering that insufficient participation of people with epilepsy in sports activities or physical exercise programs is largely due to inadequate knowledge, it would be reasonable to educate physicians, health authorities, social workers, and sports instructors about the benefit of these activities for people with epilepsy. Events and testimonials such as those cited above can have a great impact on mass media, and emphasize the capacity of people with epilepsy to live a normal life and to engage in sports activities.
References Arida, R.M., Scorza, F.A., Albuquerque, M., Cysneiros, R.M., de Oliveira, R.J., Cavalheiro, E.A., 2003. Evaluation of physical exercise habits in Brazilian patients with epilepsy. Epilepsy Behav. 4, 507—510. Arida, R.M., Scorza, F.A., Scorza, C.A., Cavalheiro, E.A., 2009. Is physical activity beneficial for recovery in temporal lobe epilepsy? Evidences from animal studies. Neurosci. Biobehav. Rev. 33, 422—431, http://www.ilaeepilepsy.org/visitors/Documents/PRESSBOOKILAE-UEFADEF.pdf. Chang, B.S., Lowenstein, D.H., 2003. Epilepsy N. Engl. J. Med 349, 1257—1266. Elliott, J.O., Jacobson, M.P., Seals, B.F., 2006. Self-efficacy, knowledge, health beliefs, quality of life, and stigma in relation to osteoprotective behaviors in epilepsy. Epilepsy Behav. 9, 478—491. Eriksen, H.R., Ellertsen, B., Gronningsaeter, H., Nakken, K.O., Løyning, Y., Ursin, H., 1994. Physical exercise in women with intractable epilepsy. Epilepsia 35, 1256—1264.
95 Haskell, W.L., Lee, I.M., Pate, R.R., Powel, K.E., Blai, S.N., Franklin, B.A., Macera, C.A., Heath, G.W., Thompson, P.D., Bauman, A., 2007. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39, 1423—1434. Leidy, N.K., Elixhauser, A., Vickrey, B., Means, E., Willian, M.K., 1999. Seizure frequency and the health related quality of life of adults with epilepsy. Neurology 53, 162—166. McAuley, J.W., Long, L., Heise, J., Kirby, T., Buckworth, J., Pitt, C., Lehman, K.J., Moore, J.L., Reeves, A.L., 2001. A prospective evaluation of the effects of a 12-week outpatient exercise program on clinical and behavioral outcomes in patients with epilepsy. Epilepsy Behav. 2, 592—600. Nakken, K.O., Bjorholt, P.G., Johannessen, S.I., Løyning, T., Lind, E., 1990. Effect of physical training on aerobic capacity, seizure occurrence, and serum level of antiepileptic drugs in adults with epilepsy. Epilepsia 31, 88—94. Roth, D.L., Goode, K.T., Williams, V.L., Faught, E., 1994. Physical exercise, stressful life experience, and depression in adults with epilepsy. Epilepsia 35, 1248—1255.
Ricardo M. Arida ∗ Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 862, Ed. Ciências Biomédicas, 5◦ andar. Vila Clementino, 04023-900 São Paulo (SP), Brazil Fulvio A. Scorza Esper A. Cavalheiro Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil Emilio Perucca Department of Internal Medicine and National Institute of Neurology, University of Pavia, Pavia, Italy Solomon L. Moshé Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore/Einstein Epilepsy Management Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA ∗
Corresponding author. Tel.: +55 11 55764513; fax: +55 11 55739304. E-mail address: [email protected] (R.M. Arida) 27 June 2011 3 July 2011 Available online 22 July 2011