Can individuals with epilepsy participate in sports?

In his latest online article, Professor Matthias Koepp explores the inclusion of individuals with epilepsy in sports, discussing necessary precautions and guidelines. It touches on restrictions in specific sports, safety measures, in particular for water activities, and the impact of sports on epilepsy management.

Can people with epilepsy take part in sports, and are there specific precautions or guidelines to follow?

While epilepsy should not pose a barrier to sports participation, certain precautions and guidelines need to be observed. Restrictions apply to motor sports and flying. In diving, similar restrictions are applied as for safe driving, with those exclusively experiencing seizures while asleep for at least 3 years considered safe to drive or dive. Specific guidelines exist for some water sports to minimise the risk of drowning.

Many sports can be made safer for individuals with epilepsy through proper safety measures. This involves assessing the activity's risk, understanding how epilepsy affects the individual, and considering potential seizure-related risks. Similarly, many sports are safe or not riskier for people with epilepsy than for others, if the epilepsy is well controlled, or for people with epilepsy who have focal rather than generalised/absence seizures. Again, the individual risk – benefit assessment is crucial. Individual risk assessment questions and safety protocols, including emergency medication accessibility and communication plans, are vital. Group participation and basic rescue training are advised to mitigate risks during sport activities.

Don't forget to weigh the risks against the benefits of the sport. The chances of serious injury are small compared with the positive effects of team participation.

How can sports-related activities impact epilepsy management and seizure control?

Studies (Haefele et al. 2021, Popp et al. 2021) suggest a positive impact of physical exercise on seizure control and cognitive performance in individuals with epilepsy. However, sustained positive effects may be challenging due to difficulties in maintaining structured exercise programs. Reaction time considerations are important for those taking medication. Overall, exercise is associated with an improved quality of life for individuals with epilepsy.

Are there specific sports or exercises that are considered safer for individuals with epilepsy?

Research (Eriksen et al. 1994, Nakken et al. 1990) indicates that exercise-related seizures are uncommon, and no specific trends toward increased seizures during or after exercise exist. Exercise-related seizures typically occur during resting periods and are unrelated to seizure type, activity mode, or pulse rate. The choice of sport should not be determined by epilepsy.

What should a coach, teammates, and sports organisations know about supporting athletes with epilepsy?

Prior to someone with epilepsy participating in any sport, clubs and coaches should conduct a thorough risk assessment. Individuals must provide comprehensive and current information through a Fact Find questionnaire, and consent should be obtained for its use in the risk assessment. Collaborative risk assessment, with input from the individual and their medical supervisor, is essential to ensure a safe and supportive sports environment.

For a person with epilepsy, what are the potential risks and challenges associated with participating in:

Water sports?

For swimming, simply informing a life-guard about the condition who can then watch from the pool-side.

For surfing or rowing, wearing a life jacket is recommended, particularly when rowing in a single, and having an informed and knowledgeable companion, such as a friend, coach, or instructor, is crucial.

Cycling or skiing?

Bicycles are a part of childhood, and skiing is a wonderful outdoor activity for many families. Yet a bicycle, if ridden on or near the street, presents a serious potential danger for a person with epilepsy. Even if a parent rides just behind the child on the sidewalk, during a complex partial seizure the child may suddenly veer off into the street, out of the parent's reach and protection. The same applies to skiing, although the landing is usually softer.

Everyone who rides a bicycle or is skiing should wear a helmet. If the seizures are under control or do not impair motor control or consciousness, bicycle riding or skiing should not be restricted. It is safer to ride bikes in a park or other safe place away from motor vehicles. Stationary bicycles for exercise pose no serious danger for the person with epilepsy. Ideally, the floor should be carpeted or padded. Low-seated bicycles are the safest.

As for safe cycling, every person who wants to ski should wear a helmet. People with epilepsy should not travel alone in a chair-lift. There are special harnesses which can be used to avoid slipping out of a chair-lift. For the elderly person, or those who have been taking certain anti-seizure mechanisms for a long time, there is an increased fracture risk, if vitamin D levels are low due to long-term use of anti-seizure medications, like phenobarbital, phenytoin, or carbamazepine.

For both cycling and skiing, many adaptations are possible for the person with epilepsy and additional learning or motor disabilities, like tandem bikes or sit-down skiing. Adaptive cycling or skiing are important for families who have several children with and without epilepsy and other disabilities to allow for integration and joint family activities.

Contact sports?

For rugby and football, the risk of injuries is not higher for people with epilepsy than for anybody else. Everyone playing rugby is aware of the risks for the neck. Strict rules need to be in place for everyone in relation to concussion, and excessive header training is not safe for anyone. Head injuries also can aggravate a seizure disorder. For a person with frequent absences or not well controlled epilepsy, the scrum is not a safe place to be, as inattention can lead to an increased risk of injury. If someone had a seizure during the game, it is probably safest to sit out the rest of the game.

Boxing should be avoided by all children, especially those with epilepsy. Boxing can directly result in head injuries. Since a momentary lapse can mean taking a hard hit directly to the head, a person with absence seizures or focal seizures with impaired awareness is at particular risk of injury from boxing. Wrestling may be safe for the person with well-controlled seizures or seizures that do not impair consciousness or motor control.

Horseback riding

Horseback riding can be safe and fun for children whose seizures are well controlled or always preceded by a warning. Hippotherapy is a recognised form of treatment that can help a child to improve physical functioning and mobility. It can also help the person with epilepsy to cope with emotional challenges and build self-confidence. Those who have seizures that could cause them to fall off the horse can ride but must be closely supervised. Someone may need to walk alongside the horse.

Competitive horseback riding often involves galloping and jumping and should only be considered for person with mild or well-controlled epilepsy.

Gymnastics or climbing?

Some forms of gymnastics can be dangerous for children with active epilepsy. Only those with well-controlled seizures should consider performing on the high bar, uneven parallel bars, vaults, or rings. Other gymnastic events, such as floor routines and the pommel horse, pose little risk. The parallel bars are of intermediate risk; the risk reflects the specific exercises being done.

Climbing, in particular free-climbing without a rope is also dangerous if seizures are not well controlled. Again, the same applies to the rules for driving or swimming: inform your climbing partner about your condition.

Professor Matthias Koepp is an esteemed neurologist with over 30 years of experience. He is also an approved ski-instructor for people with disabilities, has two sons who used to play rugby and is obsessed with rowing.

You can schedule an appointment with Professor Koepp on his Top Doctors profile.