A patient with a history of epilepsy can often participate in exercise or athletics provided attention is paid to the potential risks involved and the level of supervision available.
Evaluation of the patient:
(1) type(s) of epilepsy
(2) frequency of seizures
(3) loss of consciousness or control
(4) degree of seizure control
(5) compliance with medication
(6) presence of a defined lesion that is surgically correctable
(7) predictability of precipitating factors
(8) presence of aura or other warning signs
(9) history of previous injuries during seizures
(10) maturity and sense of responsibility
(11) level of interest in and commitment to activity participation
Evaluation of proposed activity:
(1) risk of fall injury or drowning
(2) risk to others
(3) level of contact involved
(4) presence of supervision
(5) level of physiologic stress (extremes in temperature, dehydration or electrolyte imbalance)
Absolute contraindication:
(1) scuba diving
(2) parachuting
(3) high altitude climbing
(4) hang-gliding
(5) motor racing
(6) solo piloting of an airplane or glider
(7) boxing or full contact martial arts
May be contraindicated with moderate or severe epilepsy:
(1) bicycle racing
(2) horse riding
(3) gymnastics
(4) skating
(5) endurance sports with physiologic stress
(6) rock climbing
May be contraindicated if proper supervision is not available:
(1) swimming
(2) water skiing
(3) boating, sailing or canoeing
(4) surfing and wind-surfing
Recommendations (Wingerchuk, page 247):
(1) If there is a structural cause for the epilepsy, this should be definitively treated if possible.
(2) If the patient has had a single seizure related to metabolic or toxic cause then athletics is permissible if the cause can be reliably avoided.
(3) If the patient has had a single unprovoked seizure of unknown cause, then the patient should receive antiepileptic medication and be allowed to participate in sports only when compliance has been confirmed.
Other observations:
(1) Seizures may occur when the person is cooling down after aerobic activity and particular attention should be paid during this period.
(2) A patient with simple partial seizures that do not progress to generalized seizure activity is usually able to participate in most activities.
(3) A person with (a) complex partial seizure without aura or (b) generalized tonic-clonic seizures should be restricted in the permitted activities.
(4) The patient should be counseled to avoid stimulants, illicit drugs and performance enhancing agents.
Specialty: Surgery, orthopedic, Neurology
ICD-10: ,
