Rationale: Historical guidelines for patients with epilepsy discouraged participation in sports for fear of injury or seizure exacerbation. Despite updated recommendations to the contrary, patients with epilepsy still remain more sedentary than the general population, and participate less in group sports than aged matched siblings. This has detrimental effects on psychological well-being, social development, general health, and overall quality of life. While guidelines now state that sports activities are unlikely to provoke or facilitate the occurrence of seizures and
that patients with epilepsy will not be affected adversely by indulging in any sport, there is little data on activity-specific risks. This study examined clinic notes for reports of seizure exacerbation attributed to playing football. Methods: A retrospective review of 157,709 consecutive clinic notes from the University of Virginia Neurology Clinic was performed. A text search was performed for the words “football” and “epilepsy”. The text from identified notes was reviewed to determine whether the patient was playing football and whether they carried a diagnosis of epilepsy. Notes were excluded if the patient was not currently playing football, if a seizure frequency could not be determined from a time when the patient was actively playing football, if the diagnosis was in question, or if the events included non-epileptic spells. Results: Fifty-three clinic visits on 32 patients met inclusion criteria. Of these 32 patients, 4 (12.5%) had an increase in seizures while concurrently playing football. Two of these 4 occurred in patients who had recently been weaned off anti-epileptic drugs (AEDs). In 1 other patient, there was reported non-adherence to account for exacerbation. Thus, only 1 patient (3.1%) had an exacerbation in seizures while playing football on consistent AEDs. Conclusions: This study found a low rate of seizure exacerbation of 3.1% in adolescents who play football while reliably taking AEDs, and of 12.5% in all people with epilepsy in this study. This is not higher than the 20% of subjects with seizure exacerbation that is commonly reported in the placebo control group of many anti-epileptic drug clinic trials. This suggests that contact sports such as football is unlikely to exacerbate seizures in people with epilepsy. The overall low rate of mention of football in patients with epilepsy is surprising and may be due to lack of an association or may be because football participation is generally discouraged in people with epilepsy. The result may be influenced by recall bias since it is dependent on both spontaneous report of patients and on documentation by physicians in the medical record. However, if bias is present it would likely trend toward more frequently reporting football participation in clinic notes for patients who have increased seizure frequency. This would lead to overestimation of seizure exacerbation in this data set. Funding: None