Exercise and seizures
Some people with epilepsy avoid exercise because they are afraid of seizure during the activity. However, it is extremely rare for a person to have an epileptic seizure while exercising. Rather than triggering seizures, physical activity can actually reduce the risk. Research has found that most people with epilepsy experience improved electroencephalograph (EEG) readings during and after exercise.

Exercise safety issues
You should consult doctor or physiotherapist before starting an exercise plan. General safety suggestions include:

*Avoid known seizure triggers.

*Always take your medication as prescribed.

*Ensure you keep an adequate supply of medication.

*Make sure your sporting companions are aware of your condition, and know what to do if you have a seizure.

*Always wear a medical alert bracelet.

* Wear protective gear appropriate to your sport, such as helmet or knee pads.

* Always wear a life jacket when involved in water sports.

* Activities such as contact sports, scuba diving, bungee jumping and boxing are dangerous and should be avoided.

*Avoid solo aerial sports such as hang gliding and skydiving.

* Avoid high altitude activities such as mountain climbing.

Activities to avoid in case of uncontrolled seizures
In addition to the above, people with uncontrolled seizures need to avoid certain activities altogether, including motor sports, horseback riding, gymnastics, ice activities, such as skating or hockey, skiing, solo water sports, such as sailing or wind surfing etc.

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

*Be alert to hidden dangers. For example, you are more likely to drown in the bath than in the sea.

*Swim with companions who are aware of your condition, and who are physically strong enough 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. You may need to brief them on how best to help you, if they don't already know.

Epilepsy drugs and sporting performance
Anti-epileptic drugs (AEDs) help to manage epilepsy, but some of the side effects can influence your sporting performance, including:

*Some AEDs cause fatigue, vision problems such as blurred vision, or problems with concentration or coordination.

*Physical exercise can alter the levels of AEDs in the blood. People taking AEDs who exercise regularly need to be monitored by their doctor.

*Performance-enhancing drugs such as anabolic steroids should be strictly avoided, as they interfere with AED levels in the blood.

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, electrolyte loss (due to severe dehydration), hyperthermia (elevated body temperature), hypoglycaemia (low blood sugar levels).

To avoid exercise-related epilepsy triggers follow the following suggestions:
*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.
*Take all steps to avoid head injuries.
*Don't abuse alcohol.
*Make sure you take your medication according to your doctor's directions.

The writer is a physiotherapist at Gono Bishwabidyalay, Dhaka.