Authors :
Presenting Author: Catharina Petersen, MS – Paderborn University
Franziska Van den Bongard, MS – Institute of Sports Medicine – Paderborn University; Claus Reinsberger, MD PhD – Paderborn University
Rationale:
For quite a long time, acute bouts of exercise have been discussed as a risk factor to provoke seizures in patients with epilepsy (PWE). Regular exercise on the other hand contributes greatly to maintaining health and improves the quality of life in healthy individuals and PWE. Obtaining an exercise-associated electroencephalogram (EEG) under safe and standardized conditions may provide an opportunity to assess possible electroclinical responses to exercise and possibly guide counseling of PWE. This study aimed to assess the feasibility and safety of an exercise-induced EEG protocol involving individual exercise to complete exhaustion in a cohort of PWE.
Methods:
An exhaustive bicycle ergometer test was performed on 29 PWE (20 seizure-free in the last six months) recruited in a community-based setting. None of the patients had a history of exercise-induced seizures. The exercise intervention was delivered incrementally until individual subjective exhaustion was achieved. Complete exhaustion was objectively confirmed by spiroergometry. Before and after exercise, an electroencephalogram (EEG) was obtained in supine position (10-10 system). Ten minute recordings before and thirty minute recordings after exercise were interpreted by a board-certified epileptologist (CR) who was blinded to patients and the relationship to exercise.
Results:
No clinical seizures occurred during or after the exhaustive bicycle exercise in any of the patients. EEG results are summarized in Table 1. One subclinical seizure after exercise was observed in one patient who reported the highest frequency of seizures (two per day) among subjects at baseline. This patient did not reach subjective (but objective) physical exhaustion, but all other patients were completely subjectively and objectively exhausted. Two patients with generalized epilepsies revealed generalized interictal epileptiform discharges (IEDs) after exercise, but not before. All other patients did not show any significant EEG changes after exercise. Stage 2 NREM sleep appeared in three patients before and nine patients after exercise.
Conclusions:
Exercising until individual exhaustion did not elicit clinical seizures in our cohort of PWE. The clinical significance of the increase in the frequency of IEDs and a subclinical seizure in a patient with high seizure frequency at baseline remains to be elucidated. Duration of recordings, exercise associated hyperventilation induced effects and different sleep stages may have contributed to EEG findings. Overall, EEG after exercise-induced fatigue appeared to be clinically feasible and safe in PWE. No EEG changes were observed in most PWE but few patients may exhibit an increase in IEDs.
Funding:
This research was in parts funded by a grant from the Heinz-Nixdorf-Westfalian Foundation.