Since November is National Epilepsy Awareness Month, I thought it would be appropriate to discuss some of the more recent guidance that’s come across ACSM’s editorial desk regarding epilepsy and physical activity, namely the findings laid out in this 2021 publication in Current Sports Medicine Reports.  

The topic hits close to home, quite literally — in my twenties, I rented a house with an old friend and grad school classmate who’d developed a seizure disorder later in life. Having seen him in a postictal state (the time between the seizure and when the person returns to their pre-seizure condition), I can report that the experience is disorienting both for the individual and for those around them. 

And seizures are quite common, in fact. Current estimates suggest roughly 10% of people around the world will have at least one seizure at some point in their lives. As for epilepsy itself (defined as having experienced two more unprovoked seizures), it affects roughly 65 million people worldwide. 

But for our purposes — should this common condition stop someone from being physically active? Does exercise induce seizures? Is it safe for people experiencing epilepsy to compete in sports, and if so, which ones? 

In the past, people with epilepsy were cautioned against playing most sports. The rationale is understandable. But was it correct? More recent findings seem to say “no” — with certain conditions attached. Though there does appear to be a relationship between physical stress and epilepsy, we don’t yet have enough information to come to any solid conclusions. Further, physical activity rarely triggers a seizure. The same is true of minor head injuries that someone might experience in a contact sport. Most importantly, some research has shown that aerobic activity might decrease the frequency of seizures. And since some antiepileptic medications may cause weight gain, encouraging physical activity for people experiencing epilepsy might be important even beyond the benefits that being active confers on the general population 

So which sports and activities are best? In 2015, the International League Against Epilepsy’s Taskforce on Sport and Epilepsy released a three-tiered categorization system to sort this out: Activities in Group 1 present no significant additional risk, those in Group 2 include a moderate risk of injury for the person experiencing epilepsy but not for bystanders, and those in Group 3 come with a high degree of risk of injury or death both for the individual experiencing epilepsy and for bystanders. 

Given the characteristics listed above, it’s probably not too difficult to predict into which category a particular activity might fall. Football, basketball, baseball, bowling and golf are all Group 1 activities, for example. Group 2 would include things like gymnastics, horseback riding (especially something like show jumping), canoeing, swimming and weightlifting. Group 3 activities include climbing, motorsports, skydiving and the like. 

As with any other condition, of course, it’s important for those experiencing epilepsy to speak with their medical practitioner before engaging in new activities. No two people are alike, after all, even if they share a common medical condition. 

So for National Epilepsy Awareness Month, let’s make sure we’re up to date about the physical activity recommendations for those experiencing epilepsy. As the evidence evolves, our mindset needs to evolve as well so that no one has to miss out on being active.