Epilepsy

Epilepsy

Summary

Having epilepsy does not mean a person cannot exercise. Physical activity can reduce the risk of epileptic seizures. However, since seizures can occur suddenly and without warning, a person with epilepsy needs to ensure their exercise and sporting activities are as safe as possible. Water safety is critical for a person with epilepsy

Epilepsy is a disorder of brain function that takes the form of recurring seizures. Our thoughts, feelings and actions are controlled by brain cells that communicate with each other through regular electrical impulses. A seizure occurs when sudden, uncontrolled bursts of electrical activity disrupt this regular pattern.

This can be confined to just one part of the brain or it can occur right across the brain. Communication between cells becomes scrambled and our thoughts, feelings or movements become momentarily confused or uncontrolled.

Different types of seizures will affect people in varying ways, depending on where in the brain the seizure is occurring and what functions that part of the brain controls. Seizures can disrupt any function the brain controls – movement, thoughts, sensations, behaviour, and the person’s level of consciousness.

Exercise and epilepsy

Exercise is good for everyone, but it also has important benefits for people with epilepsy. People with epilepsy and their families are commonly concerned about seizures during exercise and this fear often results in overprotection, feelings of isolation and needless restrictions on activity. 

While seizures during exercise are rare, it is important to understand how exercise affects both epilepsy and seizures, and what to do if a seizure occurs. 

In many cases, a seizure occurs suddenly and without warning, so a person with epilepsy needs to make sure their exercise and sporting activities are as safe as possible at all times. 

Exercise and epileptic seizures

It is extremely rare for a person to have a seizure while exercising. Rather than triggering seizures, your epilepsy may improve with exercise. Although the reasons are unclear, studies demonstrate that abnormalities on EEG (a test that measures the electrical activity of the brain) decrease during exercise.

Overall fitness and a feeling of wellbeing have been shown to help reduce seizure frequency. People feel better and may improve their seizure control with regular exercise. One report suggests that exercise improves self-esteem and social integration regardless of seizure control. It has also been shown that regular exercise reduces the number of overall health complaints, such as muscle pains, sleep problems, depression and fatigue.

Most sports activities are safe as long as people avoid overexertion, dehydration and hypoglycaemia (low blood sugar). If a seizure occurs, it is most likely to be after the exercise (15 minutes to three hours later).

Exercise safety issues and epilepsy

Be guided by your doctor, but general safety considerations include:

• Before starting any new exercise program, consult with your doctor or specialist.
• Pre-exercise screening is used to identify people with medical conditions that may put them at a higher risk of a experiencing a health problem during physical activity. It is a filter or ‘safety net’ to help decide if the potential benefits of exercise outweigh the risks for you. Print a copy of the pre-exercise screening tool and discuss it with your doctor or exercise professional.
• Avoid known seizure triggers.
• Always take your medication as prescribed and have an adequate supply available.
• Stay well-hydrated and drink or snack on something with sugar in it.
• Don’t continue exercising if you feel faint, lightheaded, nauseous or dehydrated.
• Don’t overexert yourself – know your limits.
• Make sure your coach and possibly teammates are aware of your condition and know what to do if you have a seizure.
• If involved in solo exercise, consider wearing a medical alert bracelet or pendant, so people can easily identify you have epilepsy.
• Wear protective gear appropriate to your sport, such as a helmet or knee pads.
• Always wear a life jacket when involved in water sports.
• Let family or friends know your walking, jogging or exercise route before you leave and how long you will be out.
• Consider carrying a mobile phone with an ICE (in case of emergency) telephone number listed.

Risky activities and epileptic seizures

In addition to the above, people with uncontrolled seizures need to be especially careful when engaging in more risky activities and should seek advice from their doctor before engaging in:

• Contact sports, scuba diving, bungee-jumping and boxing
• Solo aerial sports such as hang-gliding and skydiving
• High altitude activities such as mountain-climbing
• Motor sports
• Horseback riding
• Gymnastics
• Ice activities such as skating or hockey
• Skiing
• Solo water sports such as sailing or sailboarding.

People with epilepsy whose seizures are difficult to control need to have someone with them who knows what to do if they have a seizure, and is able to carry out the necessary seizure first aid.

Discuss your sports aspirations with your doctor. With adequate planning and precautions, you can take part in a wide range of activities.

Water safety and epilepsy

Water safety is particularly crucial, because a person who experiences a seizure while alone in water will almost certainly get into difficulty and may even drown. Suggestions include:

• Be alert – showers, baths, pools, spas and the ocean can be dangerous for anyone experiencing seizures.
• Swim with companions who are aware of your condition and who are physically strong enough to support you and know what to do if you have a seizure.
• Swim in supervised areas, such as in a public pool with an attendant or at the beach between the flags, where lifeguards are on patrol.
• Tell the pool attendant or lifeguard that you have epilepsy and the type of seizures you experience. You may need to brief them on how best to help you, if they don’t already know.
• People with epilepsy, even if well controlled, should never swim alone.

Anti-epileptic medications and exercise

Anti-epileptic medications are the most common treatment for epilepsy and seizures, but some of the side effects may influence your performance, including:

• Fatigue and tiredness – which can be a problem for active people
• Other problems – such as blurred vision or problems with concentration, impaired coordination and slower response times
• Exercise – can alter the levels of anti-epileptic medications in the blood. People taking anti-epileptic medications who exercise regularly should discuss with their doctor the need to have their blood levels monitored (especially in the first few months of training)
• Anabolic steroids – don’t take anabolic steroids, as they interfere with anti-epileptic medication levels in the blood
• Anti-epileptic medications may lead to bone loss (osteopaenia and osteoporosis) – large studies suggest a doubling of fracture risk in people with epilepsy. Weight-bearing exercise can help prevent these conditions. Discuss appropriate activities with your doctor.

Exercise-related epilepsy triggers

It is important to exercise sensibly. You could trigger a seizure minutes or hours after exercise if you unnecessarily strain your body. Exercise-related risk factors could include:

• Extreme fatigue
• Lack of sleep
• Dehydration (and electrolyte loss, due to severe dehydration)
• Hyperthermia (elevated body temperature)
• Hypoglycaemia (low blood sugar levels).

Suggestions to help you avoid these triggers include:

• Make sure you take your medication according to your doctor’s directions.
• Drink plenty of water before, during and after exercise.
• Don’t push yourself to the point of physical exhaustion.
• If you are feeling very hot and tired, slow down or stop.
• Make sure you have at least two rest days every week.
• Make sure your diet is nutritionally adequate.
• Get plenty of rest and good quality sleep.
• Limit or abstain from alcohol.

Things to remember

• Exercise is good for everyone, but it also has important benefits for people with epilepsy as the condition may improve with exercise.
• Take all necessary safety precautions while exercising.
• Anti-epileptic drugs can affect sporting performance.

Myotherapy 

Summary

Myotherapy is a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement. The philosophy of myotherapy is founded on Western medical principles including anatomy, physiology and biomechanics. Techniques may include massage, stretching, acupressure and myofascial dry needling.

yotherapy is a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement caused by muscle or myofascia dysfunction. Myofascia are the thin, fibrous sheets of tissue that surround and separate muscles. Ligaments and tendons are comprised of bundled myofascia.

The philosophy of myotherapy is founded on Western medical principles including anatomy, physiology and biomechanics. You don’t need a referral from a doctor to make an appointment with a myotherapist.

Symptoms of soft tissue pain

Pain that is caused by muscle tissue or muscle fascia (myofascia) is called myofascial pain. Symptoms can include:

• deep and constant aching
• muscle tightness
• sore spots in the muscle (myofascial trigger points)
• reduced joint mobility
• stiff joints
• numbness
• recurrent tingling, prickling or ‘pins and needles’ sensation
• unexplained tiredness.

Myotherapy can treat a range of disorders

Myotherapy can be used to treat a wide range of disorders including:

• overuse injury such as tennis elbow or shin splints
• some sports injuries
• tension headache
• pain caused by poor posture
• some types of chronic back pain
• some types of joint pain, such as shoulder impingement syndrome
• muscle sprains.

What to expect at your first myotheray appointment

For your first appointment, take any medical test results (such as x-ray films) that relate to your condition. The myotherapist will ask many questions about your symptoms. Tell them about your medical history, including prior illness and surgery. Give them a list of all the medicines you are currently taking. This information is kept in strictest confidence and is used by the therapist to help pinpoint the cause of your symptoms.

The myotherapist will examine and manipulate the affected joints and associated muscles, and test your reflexes. This initial examination is thorough and helps the myotherapist to find out if the symptoms are myofascial. The myotherapist may refer you to other healthcare professionals for further diagnosis or treatment, depending on your medical condition.

Myotherapy techniques

Treatment depends on the diagnosis. Myotherapy uses a range of techniques including:

• massage, including sports and remedial techniques
• gently moving the patient’s affected body part through its range of motion (passive stretching)
• hot or cold therapy
• transcutaneous electrical nerve stimulation (TENS) therapy
• trigger point therapy (acupressure)
• myofascial dry needling.

Most people with myofascial dysfunction will have pain relief within one to three sessions. Each session typically lasts one hour.

Self-help suggestions

The myotherapist will explain your condition in detail. Dietary changes could be recommended. The myotherapist may advise treatments to use at home including:

• exercises and stretches specific to your condition
• self-administered massage
• heat packs
• ice packs
• relaxation techniques including meditation.

Ongoing management with myotherapy

The myotherapist will work with you to identify factors that may be making your condition worse (such as poor posture, scoliosis or overtraining) and help you find ways to avoid or reduce these aggravating factors.

If something cannot be changed (for example, arthritis or age-related changes to spinal discs), the myotherapist will develop a pain management program. This may involve referral to other healthcare professionals. 

For acute or persistent joint pain, always see your doctor.

Finding a myotherapy practitioner

Suggestions for finding a practitioner include:

• Contact the Australian Association of Massage Therapists and ask for a list of members in your area.
• Ask your doctor or healthcare professional for a referral.
• Ask your friends for word-of-mouth recommendations.

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Things to remember

• Myotherapy is a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement.
• The philosophy of myotherapy is founded on Western medical principles including anatomy, physiology and biomechanics.
• You don’t need a referral from a doctor to make an appointment with a myotherapist.

Post-traumatic stress disorder (PTSD)

Summary

Post-traumatic stress disorder (PTSD) is a mental health problem that can develop in people who have experienced or witnessed an event that threatens their life or safety, or that of those around them. This can be a car or other serious accident, physical or sexual assault, war-related events or torture, or natural disasters such as bushfires or floods. Effective treatments are available for PTSD.

Post-traumatic stress disorder (PTSD) is a mental health problem that can develop in people who have experienced or witnessed a traumatic event that threatens their life or safety (or others around them). This could be a car or other serious accident, physical or sexual assault, war-related events or torture, or a natural disaster such as bushfire or flood.

Other life-changing situations such as being retrenched, getting divorced, or the death of an ill family member are very distressing, and may cause mental health problems, but are not considered traumatic events that can cause PTSD.

Anyone can develop PTSD following a traumatic event, but people are at greater risk if:

• the event involved physical or sexual assault
• they have had repeated traumatic experiences such as sexual abuse or living in a war zone
• they have suffered from PTSD in the past.

Symptoms of PTSD

A person with PTSD has four main types of difficulties, being:

• re-experiencing the traumatic event – through unwanted and recurring memories and vivid nightmares. There may be intense emotional or physical reactions when reminded of the event. These can include sweating, heart palpitations or panic
• avoiding reminders of the event, such as thoughts, feelings, people, activities or situations that bring back memories of the event
• negative changes in feelings and thoughts, such as feeling afraid, guilty, flat or numb, developing beliefs such as ‘I’m bad’ or ‘The world’s unsafe’, and feeling cut off from others
• being overly alert or ‘wound up’ – sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the lookout for signs of danger.

People with PTSD can also have what are termed ‘dissociative experiences’, which are frequently described as:

• ‘It was as though I wasn’t even there.’
• ‘Time was standing still.’
• ‘I felt like I was watching things happen from above.’

A health practitioner may diagnose PTSD if a person has symptoms in each of the four areas for a month or more, which lead to significant distress, or impact on their ability to work and study, their relationships and day-to-day life.

It is not unusual for people with PTSD to experience other mental health problems at the same time.
Up to 80 per cent of people who have long-standing PTSD develop additional problems, most commonly depression, anxiety, and alcohol or other substance misuse. These may have developed directly in response to the traumatic event or have developed sometime after the onset of PTSD. 

Impact of PTSD on relationships and day-to-day life

PTSD can affect a person’s ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem disinterested or distant as they try not to think or feel in order to block out painful memories. They may stop them from participating in family life or ignore offers of help. This can lead to loved ones feeling shut out. 

It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends, but may not think that they need help. There are many ways you can help someone with PTSD. 

Risky alcohol and drug use with PTSD

People commonly use alcohol or other drugs to blunt the emotional pain that they are experiencing. Alcohol and drugs may help block out painful memories in the short term, but they can get in the way of a successful recovery. 

When to seek help for PTSD

A person who has experienced a traumatic event should seek professional help if they:

• don’t feel any better after two weeks
• feel highly anxious or distressed
• have reactions to the traumatic event that are interfering with home, work and relationships
• are thinking of harming themselves or someone else.

Some of the signs that a problem may be developing are:

• being constantly on edge or irritable
• having difficulty performing tasks at home or at work
• being unable to respond emotionally to others
• being unusually busy to avoid issues
• using alcohol, drugs or gambling to cope
• having severe sleeping difficulties.

Support is important for recovery

Many people experience some of the symptoms of PTSD in the first couple of weeks after a traumatic event, but most recover on their own or with the help of family and friends. For this reason, formal treatment for PTSD does not usually start for at least two weeks or longer following a traumatic experience. 

It is important during those first few days and weeks after a traumatic event to get whatever help is needed. This may include information and access to people and resources that can help you to recover. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start, to get further help. 

Treatment for PTSD

If problems persist after two weeks, a doctor or a mental health professional may discuss starting treatment. Effective treatments are available. Most involve psychological treatment, but medication can also be very helpful. Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem. 

The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through thoughts and beliefs associated with the experience. Trauma-focussed treatments can:

• reduce PTSD symptoms
• lessen anxiety and depression
• improve a person’s quality of life
• be effective for people who have experienced prolonged or repeated traumatic events, but treatment may be required for a longer period.

Things to remember

• PTSD develops in some people after they experience or witness an event that threatens their life or safety, or that of others around them.
• Symptoms include vivid memories, feeling constantly on edge and avoiding reminders of the event.
• It is common for people to have some of the symptoms of PTSD in the first few days after the traumatic event. Most will recover by themselves or with the support of family and friends. Others may need professional help.