Seizure Disorders and Physical Education
By Jennifer Kosoy, Undergraduate student in the College of Health and Human Performance, University of Florida, Gainesville, Florida

The brain functions properly by sending electrical impulses to receptors such as the spinal cord, nerves, or muscles to communicate information. If anything goes wrong in one part of the brain, abnormal messages can be sent throughout the entire brain and information pathway causing a seizure. Anyone can have a seizure, and there are many possible causes for this brain malfunction to occur. Students with seizure disorders are still able to participate in their school's physical education program, but there are adjustments that should be made for their safety.

Seizure disorders can either start in early childhood or in later years as an adult. In fact, about two percent of adults have, at some time in their lives, had a seizure (1). The typical causes for acquiring seizure disorder before age two are high fevers or metabolic disorders. For those that have seizures between ages 2-14, the cause is usually unknown, and these seizures are referred to as idiopathic. People that have seizures after age 25 usually owe it to brain damage caused by such occurrences as head injury, stroke, or having a tumor; however, half of the cases in this age group are idiopathic as well (1). In addition to those with seizure disorders, anyone can have an isolated seizure, where they have only one in their entire lifetime. This type of seizure is caused by lack of sleep, physical and emotional stress, drugs, low blood oxygen or low blood sugar, among other possible reasons.

There are many types of seizure disorders, and they can be partial or generalized. Partial seizures affect only half of the brain and do not involve a loss of consciousness, while generalized seizures affect both sides of the brain and do include loss of consciousness. However, a partial seizure can actually spread throughout the brain and become a generalized seizure (2). Simple partial seizures, Jacksonian seizures, complex partial seizures, and epilepsia partialis continua are all examples of partial seizures. Tonic-clonic seizures, primary generalized epilepsy, absence seizures, atonic seizures, myoclonic seizures, and status epilepticus are all examples of generalized seizures. Most people with a seizure disorder (about 70%) have only one type of seizure disorder (1).

Seizures are very quick, usually lasting 2-5 minutes long; some are much quicker, though, such as absence seizures that last only a few seconds, and some are much longer, such as status epilepticus, which can last longer than 15 minutes. The symptom signaling the start of a seizure is called an aura; this symptom indicates to a person that a seizure is about to occur. An aura is characterized by unusual senses of smell, taste, or vision. Depending on which part of the brain is affected, the signs of a seizure can differ. If the abnormal electrical discharge is in the part of the temporal lobe that controls smell, a person will sense either a really good or really horrible smell. In a different part of the temporal lobe, a person might experience déjà vu. If the frontal lobe is affected, a person might not be able to speak, and, if large parts of the brain are affected at once, convulsions may occur, in addition to numbness, loss of consciousness, and loss of muscle and bladder control (1). After having a seizure, a person is in a postictal state. This state is associated with headaches, sore muscles, and confusion.

There are a few techniques used to diagnose seizure disorders. The main method is to use an electroencephalogram (EEG) (Figure 1). This device records the brain's electrical activity (Figure 2) and helps doctors to find the locations of the brain abnormalities. Other techniques for diagnosing include magnetic resonance imaging (MRI), which gives clear pictures of the brain, and functional magnetic resonance imaging (fMRI) performed during activity, which shows changes in electrical intensity and blood flow. In addition, position emission tomography (PET) and single photon emission tomography (SPECT) can be used to diagnose seizure disorders. These methods show where in the brain metabolic changes occur between seizures (2).

Another great resource for helping to diagnose a person with seizure disorder is to have an account from a bystander. This witness would know more of what occurred before, during, and after a seizure than the person having the seizure would be able to remember. The witness can pay attention to such details as to how long the seizure lasted, what it included, and whether the patient had any warning signs. The witness should relay all of this information to the physician.

(MRI), which gives clear pictures of the brain, and functional magnetic resonance imaging (fMRI), performed during activity, which shows changes in electrical intensity and blood flow. In addition, position emission tomography (PET) and single photon emission tomography (SPECT) can be used to diagnose seizure disorders. These methods show where in the brain metabolic changes occur between seizures (2). Another great resource for helping to diagnose a person with seizure disorder is to have an account from a bystander. This witness would know more of what occurred before, during, and after a seizure than the person having the seizure would be able to remember. The witness can pay attention to such details as to how long the seizure lasted, what it included, and whether the patient had any warning signs. The witness should relay all of this information to the physician.

There are treatments that can be used for people with seizure disorders. An example is giving glucose to a patient that has seizures due to hypoglycemia (1). For seizures with unknown causes, anticonvulsants can be used. It can often take several months to determine exactly which anticonvulsant works best for an individual's seizures. Each person taking these drugs should wear a Medic Alert bracelet that has the type of seizure disorder and type of anticonvulsant prescribed inscribed on it (1). In addition to taking anticonvulsants, a patient may also have electrical stimulation of their vagus nerve. A 2003 study revealed that vagus nerve stimulation reduced partial seizures by more than 50% in one third of patients who received it (2).

Exercise and social activities are greatly encouraged for those with seizure disorders. A study was done researching methods elementary school teachers can use when dealing with students with seizure disorders. The teachers indicated they often felt uneducated about the condition and unsure of how to handle a situation in which their student might have a seizure at school. This led them to being opposed to letting these students participate in sports and social activities. However, after attending a seminar on seizure disorders, their negative attitudes toward the students' participation decreased (3).

The fact is, children with seizure disorders can and should participate in physical education as long as the teacher is aware of what to do in the event a seizure occurs. Some important responsibilities include removing sharp objects from the area, rolling the student onto his or her side to open the airway, and placing something soft beneath the head. A teacher should not try to put anything in the student's mouth, hold the student down, or give CPR (4). Following these guidelines is crucial to maintaining the health and safety of the child. There are some activities that are contraindicated for students with seizure disorders, and these include anything that would require getting off the ground. For example, balance beam, rock climbing, rope climbing, and other such activities should all be avoided. Water activities, such as swimming and diving, should be closely monitored as well (4).

There are definite physiological and psychological benefits for people with seizure disorders to participate in physical activity. Engaging in physical activities with peers raises self-esteem, which improves quality of life (5). Other benefits are the same as for any person who exercises: lowered risk for obesity, hypertension, diabetes, and heart disease, and decreased stress (5). A recent study completed in Norway reported those with seizure disorders felt better, and had better seizure control when involved with a regular exercise program (6). Yoga is a specific physical activity especially beneficial to those with seizure disorders. Yoga helps people to relax and relieve stress, and because stress is a major contributor to the onset of a seizure, yoga can help reduce the occurrence (2). Although there are seizure causes that may arise during sports participation, such as fatigue or stress of competition, there are no studies that specifically reveal sports as a cause of a seizure (6).

Individuals with seizure disorder can participate in many activities. The activities should be altered for safety, and the students should be monitored when playing. Bicycling is a fun activity that a child with a seizure disorder can enjoy as long as a helmet is worn at all times (6). Exercising on a stationary bicycle is the safest choice because it limits the possibility of falling. Activities that improve the cardiorespiratory system are great because they may lead to reduced seizures (7). Some of these activities include hiking, jogging, dancing, and low intensity aerobics. Games such as basketball, floor hockey, soccer, and softball can be adapted by using smaller playing areas, making them easier to monitor.

Another softball adaptation would be to use a batting tee to prevent getting hit in the head by a wild pitch. Bowling can also be adapted by using lighter balls to make a lower intensity activity. Gymnastics can be included by choosing activities close to ground level (7), such as using a plank of wood on the floor as a balance beam so that students are not likely to fall. In all cases, it is essential that children with seizure disorders use the buddy system when participating in physical activity. Having a partner is important so that the teacher can be notified if a seizure is to start.

Overall, as long as safety precautions and activity adjustments are in place, there is no reason why a person with seizure disorders should not be a part of a physical education program. There are clear health benefits to exercise, as there are with people without seizure disorders, and certain types of stress-relieving exercises can even reduce seizures from happening. There are many types of seizure disorders, and the fact that most causes are unknown can be very scary and dangerous. Educators, friends, and family members should all be aware of what to do in the event someone around them has a seizure. Anyone can have a seizure at any time, and it is important to know what to do to ensure a safe recovery for them.

 

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