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Zhang J, Yu Y, Chen Z, Wang Y. Trends and disparities in the prevalence of physical activity among US adults with epilepsy, 2010-2022. Epilepsy Behav 2024; 157:109850. [PMID: 38820682 DOI: 10.1016/j.yebeh.2024.109850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/06/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Physical activity may be associated with health benefits for people with epilepsy. It remains unclear how the prevalence of physical activity has changed at a national level over the years and whether this prevalence varies between subgroups. METHODS The National Health and Interview Survey, which was conducted from 2010 to 2017 and again in 2022, was used for our nationally representative study. This study explored the trends and disparities in meeting physical activity guidelines among US individuals with epilepsy and non-epilepsy adults. RESULTS The prevalence of adults with epilepsy meeting physical activity guidelines was consistently lower and remained unchanged compared to those without epilepsy. Among the population with epilepsy, the prevalence of aerobic physical activity was 38.1 % (95 % CI, 32.6 %-43.5 %) in 2010 and 39.0 % (95 % CI, 33.4 %-44.7 %) in 2017 (P for trend = 0.84), and remained unchanged in 2022 (39.1 %). For muscle-strength training, the prevalence was 17.5 % (95 % CI, 13.3 %-21.7 %) in 2010 and 18.8 % (95 % CI, 14.8 %-22.8 %) in 2017 (P for trend = 0.82). The prevalence for both activities combined was 12.4 % (95 % CI, 8.7 %-16.2 %) in 2010 and 16.6 % (95 % CI, 12.8 %-20.5 %) in 2017 (P for trend = 0.26). The prevalence of aerobic physical activity varied by educational attainment, body mass index, comorbid conditions, alcohol-drinking status, and epilepsy status. CONCLUSION This study suggests that the adherence rate to meeting physical activity guidelines among US adults with epilepsy was at a low level and had not improved over time. This finding highlights the need for additional nationwide efforts to promote physical activity in the US population with epilepsy.
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Affiliation(s)
- Jiajun Zhang
- Qingdao Municipal Hospital, No.1 Jiaozhou Road, Qingdao, Shandong 266011, China
| | - Yue Yu
- Qingdao Municipal Hospital, No.1 Jiaozhou Road, Qingdao, Shandong 266011, China
| | - Zhibin Chen
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Australia
| | - Yan Wang
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
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Alfonso D, Ailion A, Semaan N, Davalbhakta E, Bearden DJ. Effects of physical activity on cognition and psychosocial functioning in pediatric epilepsy: A systematic review. Epilepsy Behav Rep 2024; 27:100700. [PMID: 39184195 PMCID: PMC11342123 DOI: 10.1016/j.ebr.2024.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Pediatric patients with epilepsy often have psychosocial and cognitive difficulties. Physical activity has emerged as a lifestyle modification that may reduce seizure burden, enhance brain plasticity, and improve cognitive and psychosocial comorbidities. We systematically reviewed published studies examining the effect of physical activity on cognitive and psychosocial function in children and adolescents with epilepsy. Studies were identified with PubMed and Emory Library databases. Eleven studies met inclusion criteria. Six of 10 studies related to psychosocial outcomes showed benefits of physical activity in children and adolescents with epilepsy, including improvements in internalizing symptoms, relationships, self-esteem, and psychological well-being, but four of the 10 studies showed no psychosocial benefits. Of the six studies evaluating cognitive outcomes, all six indicated that physical activity was associated with cognitive improvements in pediatric epilepsy, including areas of attention, processing speed, executive function, and memory. Our review was limited by the paucity of published studies on this topic, and the use of different measurement tools limited our ability to make direct comparisons between studies. Additional studies that compare pediatric epilepsy populations to non-epilepsy control groups are needed to better understand how physical activity affects seizure control and epilepsy-related comorbidities.
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Affiliation(s)
- Demy Alfonso
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Georgia, USA
- Department of Psychology, Northern Illinois University, Illinois, USA
| | - Alyssa Ailion
- Department of Neurology and Psychiatry, Boston Children’s Hospital, MA, USA
- Department of Psychology, Harvard Medical School, Massachusetts, USA
| | - Nicole Semaan
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Neuroscience and Behavioral Biology, Emory University, Georgia, USA
| | | | - Donald J. Bearden
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Georgia, USA
- Department of Pediatrics, Division of Neurology, Emory University School of Medicine, Georgia, USA
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Hu Z, Tang L, Xu X, Zhan Y. Association between physical activity and psychosocial status in adults with epilepsy: Results from the 2022 National health Interview survey. Epilepsy Behav 2024; 156:109836. [PMID: 38761448 DOI: 10.1016/j.yebeh.2024.109836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE The study aimed to investigate the association between physical activity and the four dimensions of psychosocial status in adults with epilepsy. METHODS The data of individuals with epilepsy utilized in this cross-sectional study were derived from the 2022 National Health Interview Survey(NHIS). Physical activity was analyzed based on walking, moderate or vigorous intensity physical activity and the 2018 Physical Activity Guidelines (PAG) for Americans. The psychosocial status of the participants was assessed using self-report questionnaires that evaluated life satisfaction, symptoms of depression and anxiety, and social functioning. A multivariate ordinal regression model was employed to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) following adjustment for potential confounding factors. RESULTS In total of 424 individuals with epilepsy(mean age:48.0 years; male: 40.6 %) were included in this study. About 39.9 % of the participants met the 2018 PAG for aerobic activity. After controlling for potential confounding factors, individuals who adhered to the 2018 PAG for aerobic activity were found to have a higher likelihood of reporting increased life satisfaction (OR, 0.39; 95 % CI: 0.21, 0.71), decreased symptoms of depression (OR, 0.53; 95 % CI: 0.30, 0.94), and improved social functioning (OR, 0.42; 95 % CI: 0.24, 0.74). However, no significant association was observed between physical activity and anxiety symptoms among individuals with epilepsy. CONCLUSIONS This study emphasizes that moderate to vigorous physical activity enhances psychosocial health in individuals with epilepsy. Nevertheless, it is important to note that a causal relationship cannot be inferred from these findings, and further verification through randomized controlled trials is necessary.
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Affiliation(s)
- Zhao Hu
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China
| | - Lu Tang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiaowei Xu
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
| | - Yiqiang Zhan
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Liao W, Lu L, Xiong W, Mu J, Zhou D. Epileptologists' attitudes toward physical exercise and sports for persons with epilepsy in China. Epilepsy Behav Rep 2024; 27:100685. [PMID: 38953099 PMCID: PMC11215944 DOI: 10.1016/j.ebr.2024.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 07/03/2024] Open
Abstract
We undertook a survey among epileptologists in China to explore their attitudes toward physical exercise and sports for persons with epilepsy (PWEs). A total of 288 epileptologists participated. Most recognized the potential benefits of physical exercise and sports for PWEs, including improved cognitive function (74.6 %), alleviation of mental disorders (73.2 %), and enhanced quality of life (83.8 %). Epileptologists overwhelmingly agreed on the importance of discussing and encouraging physical exercise and sports for PWEs (97.4 % and 95.2 %, respectively). Before engagement in physical exercise and sports, most epileptologists considered that the duration of seizure-free status could be shorter if the seizures were typically focal, non-motor, or without impaired awareness (p < 0.05). There was consensus (99.1 %) on the need to grade the risk of related activities. Opinions were divided regarding the use of health certificates for restricting PWEs (favored by 63.2 %). The majority (93.9 %) called for an expert consensus or clinical guidelines in China. In conclusion, epileptologists in China generally demonstrate a positive attitude toward physical exercise and sports for PWEs. Both benefits and risks of these activities have generally been acknowledged. It is recommended to prioritize activities with lower risks and higher benefits. However, the recommendations for PWEs with a lower likelihood of recurrence and less risky seizure types can be more liberal. Urgent development of normative guidance from governmental and professional bodies is warranted.
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Affiliation(s)
- Weihao Liao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan, China
| | - Lu Lu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Weixi Xiong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jie Mu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Sauls RM, Buro AW, Kirby RS. Lifestyle Behavioral Interventions and Health-Related Outcomes Among People with Epilepsy: A Review of Randomized Controlled Trials. Am J Health Promot 2024; 38:720-730. [PMID: 38414186 DOI: 10.1177/08901171241235731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To gather and assess current literature on the prevalence and efficacy of lifestyle behavioral interventions (sleep, nutrition, physical activity) for health outcomes, including QOL, psychological well-being, behavioral changes, and seizure frequency, among PWE. DATA SOURCE A review was conducted of English-language articles identified from PubMed, Scopus, and Embase between January 2013 to January 2023. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria were randomized controlled trials (RCT) with human subjects diagnosed with epilepsy who participated in a lifestyle behavioral intervention. DATA EXTRACTION Two researchers independently completed the title, abstract, and full-text reviews. Information extracted includes study population, duration, type of intervention, findings, and outcomes. DATA SYNTHESIS Data was narratively synthesized to show level of evidence and degree of consistency in findings. Results: 4001 studies identified, 66 full texts reviewed, and 24 included. A majority (n = 16) of studies utilized diet specific RCTs, and some focused on physical activity (n = 7) and sleep (n = 1). Diet-specific RCTs (eg, ketogenic, Modified Atkins) reported reduced seizure frequency with adverse effects, such as gastrointestinal complications. Physical activity-based interventions found that maintained levels of exercise improved QOL and psychological well-being. However, physical activity and diet-based interventions did not have lasting effects after study conclusion. Only the behavioral sleep intervention reported that sleep quality improved significantly and was maintained post-intervention. CONCLUSION Future research is needed to establish the relationship between lifestyle behavioral interventions on QOL and other health outcomes (eg, seizure frequency).
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Affiliation(s)
- Rachel M Sauls
- Department of Non-Therapeutic Research Operations, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Acadia W Buro
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, FL, USA
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Vitor-de-Lima SM, Figueira de Oliveira ML, Tavares IDS, Leandro CVG, Guedes RCA. Maternal voluntary physical exercise in the adult rat: evidence of exercise-associated differences in maternal food intake, and in brain effects on the progeny. Nutr Neurosci 2024; 27:120-131. [PMID: 36633889 DOI: 10.1080/1028415x.2023.2166415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objectives: Maternal physical activity may impact behavioral and electrophysiological aspects of brain function, with short- and long-term effects on pre- and postnatal neurodevelopment of the offspring. This study evaluated in the rat the effects of maternal voluntary physical activity (MVPA) on food intake and weight gain in the dams, as well as anxiety-like behavior, short-term memory and the brain excitability-related phenomenon known as cortical spreading depression (CSD) on the mother-pup dyad.Methods: Female Wistar rats (n=33) were individually housed in cages containing a running wheel for a 30-days adaptation period before mating. Rats were classified as inactive (I); active (A) or very active (VA) according to the distance spontaneously travelled daily. During gestation, the dams continued to have access to the running wheel. Mothers and their respective pups (1 pup per mother) were evaluated in the open field test (OFT), object recognition test (ORT), elevated plus maze test (EPMT) and the CSD propagation features.Results: MVPA was directly associated with increased food intake and weight gain during gestation, and maternal anxiolytic-like behavioral responses in the OFT. Pups from VA mothers showed a high discrimination index for shape recognition memory (ORT) and decreased propagation velocities of CSD, when compared with the inactive group.Discussion: The data suggest that MVPA during the gestational period induces neuroplasticity and may modulate the brain functions in the mother-infant dyad in the rat.
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Affiliation(s)
| | | | | | - Carol Virgínia Góis Leandro
- Department of Nutrition, Federal University of Pernambuco, Recife, Brazil
- Department of Nutrition, CAV, Federal University of Pernambuco, Vitória de Santo Antão, Brazil
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Arida RM, Teixeira-Machado L. Physical exercise for children and adolescents with epilepsy: What have we learned? Seizure 2023; 111:1-8. [PMID: 37480838 DOI: 10.1016/j.seizure.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE Although clinical and experimental studies have extensively evidenced the positive effect of physical exercise on epilepsy, these benefits in children and adolescents with epilepsy have been less investigated. We explored the published literature evaluating the impact of long-term exercise programmes on seizure frequency and quality of life in children/adolescents with epilepsy. METHODS A scoping review of the literature was performed in accordance with PRISMA guidance with suitable search terms. A comprehensive search of PubMed, PEDro, Web of Science, Scopus, Google Scholar and SPORTDiscus with Full Text (EBSCO) was performed from March to April 2023. A methodological quality assessment was completed for the included studies. The included studies were analysed qualitatively to identify key themes and provide a narrative description of the evidence by two reviewers. RESULTS Of 1,316 papers screened, 13 studies were selected for full reading. Only six studies evaluated the seizure frequency and quality of life in children and adolescents with epilepsy after a long-term exercise programme. Two studies observed positive findings in seizure frequency and three in quality of life. No study was classified with strong methodological quality. Three studies presented good quality 78-61%, one study presented adequate quality 57%, and two studies presented poor methodological quality (39% and 43%). CONCLUSIONS Our review highlights a limited number of investigations evaluating the long-term effect of exercise in children and adolescents with epilepsy. Longitudinal investigations with good methodological quality may be performed to examine the effectiveness of exercise in this population.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.
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Cameron S, Grady KM, Kent SP, Sousa MM. Mild to moderate increases in activity are associated with increased seizure incidence in dogs with idiopathic epilepsy receiving anti-epileptic drugs. J Small Anim Pract 2023; 64:611-618. [PMID: 37572005 DOI: 10.1111/jsap.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Epilepsy is a chronic disorder, and approximately 25% to 30% of dogs with epilepsy are refractory to anti-epileptic drugs. As increased activity has been shown to reduce seizure frequency in people with epilepsy, the goal of this study was to evaluate the relationship between deviation from baseline activity and seizure incidence in dogs with epilepsy. MATERIALS AND METHODS Activity and seizure data were obtained using a canine activity monitoring device and owner observed seizure logs in 53 dogs with idiopathic epilepsy receiving anti-epileptic drugs. Each dog's activity was individually measured, and 14-day baseline averages were calculated. Logistic regression was performed to evaluate how an observed increase in activity, ranging from 0% to 50%, above baseline activity, affects the incidence of a seizure in the following 24 hours. RESULTS A total of 8540 activity days and 365 seizure days were used in the final analysis with an average of 11 seizures per dog (range 0 to 30 seizures). Seizure incidence was significantly more likely when activity was 10%, 20%, or 30% above baseline activity in the 24 hours before the day of a documented seizure [95% confidence interval (1.02 to 1.60), P=0.033; 95% confidence interval (1.08 to 1.80), P=0.010; 95% confidence interval (1.13 to 2.07), P=0.005, respectively]. However, when activity levels were 40% and 50% above baseline, the effect diminished (95% confidence interval (0.74 to 1.70), P=0.532; or 95% confidence interval (0.56 to 1.66), P=0.988, respectively). CLINICAL SIGNIFICANCE Differently than in humans, this study demonstrated that a mild to moderate increase in activity resulted in a higher seizure incidence within 24 hours in dogs with epilepsy.
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Affiliation(s)
- S Cameron
- Department of Medical Sciences, University of Wisconsin, Madison, WI, USA
| | - K M Grady
- Clinical Sciences, North Carolina State University, Raleigh, NC, USA
| | - S P Kent
- Department of Statistics, University of Wisconsin - Madison, Madison, WI, USA
| | - M M Sousa
- Ocean State Veterinary Specialists, RI, East Greenwich, USA
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Aktar B, Balci B, Eraslan Boz H, Oztura I, Baklan B. Yoga and aerobic exercise in epilepsy: Study protocol for a randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2013. [PMID: 37151132 DOI: 10.1002/pri.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND There has been a growing interest in demonstrating the health benefits of exercise among people with epilepsy in recent years. Although exercise is recommended for people with epilepsy, there is uncertainty concerning the effects of yoga and aerobic exercise on multiple health outcomes in epilepsy. PURPOSE The aim of this trial was to examine the effects of yoga and aerobic exercise training on physical activity, seizure frequency, health-related physical fitness, mental, emotional, and psychological health status, and quality of life. METHODS This study was designed as a single-center, 8-week, randomized controlled trial in a three-arm parallel group. Participants will be randomly allocated to yoga, aerobic exercise, or wait-list control groups. The primary outcome is physical activity/sedentary behavior measured by the ActiGraph GT9X accelerometer and seizure frequency. Secondary outcomes include functional capacity, lower extremity strength, balance, body composition, waist and hip circumference, cognition, depression, anxiety, perceived stress, fatigue, sleep quality, and quality of life. The outcomes will be evaluated at baseline and at 8 weeks of follow-up. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE This study is the first randomized controlled trial comparing the effects of yoga and aerobic exercise among people with epilepsy. The findings of this study could provide important information about the effects of yoga and aerobic exercise training on a variety of health conditions in people with epilepsy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05066880, registered October 4, 2021.
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Affiliation(s)
- Burcin Aktar
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Birgul Balci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Hatice Eraslan Boz
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
- Department of Neurology, Unit of Neuropscyhology, Dokuz Eylul University, Izmir, Turkey
| | - Ibrahim Oztura
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Baris Baklan
- Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Arida RM. Physical Exercise as a Strategy to Reduce Seizure Susceptibility. PHARMACORESISTANCE IN EPILEPSY 2023:453-477. [DOI: 10.1007/978-3-031-36526-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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de Lima Rosa G, Guzzo EFM, Nunes SEB, Padilha RB, Domingues AM, Barbosa BB, Siqueira IR, Coitinho AS. Aerobic exercise, alone or combined with an anti-inflammatory drug, reduces the severity of epileptic seizures and levels of central pro-inflammatory cytokines in an animal model of epileptic seizures. Epilepsy Res 2022; 186:107018. [PMID: 36126608 DOI: 10.1016/j.eplepsyres.2022.107018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
Epilepsy is a chronic neurological disorder and there is increasing evidence about the role of inflammation in epileptogenesis. These findings have spurred the search for new immunomodulatory approaches that can improve prognosis. Using an animal model of chemically-induced epileptic seizures, we tested exercise alone as non-pharmacological therapy, and exercise combined with an anti-inflammatory drug. Five groups were used: sedentary, diazepam, aerobic exercise alone, aerobic exercise combined with an anti-inflammatory drug, and naive control. Our goal was to compare the severity of the epileptic seizures between groups as well as seizure latency in a pentylenetetrazole-induced paradigm. Cytokine levels (IL-1β, TNF-α, and IL-10) were measured. Both exercise groups showed a reduction in seizure severity and lower levels of pro-inflammatory cytokines in the cortex, while the levels of cytokines in the hippocampus remained unaffected.
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Affiliation(s)
- Gabriel de Lima Rosa
- Postgraduate Program in Biological Sciences, Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Edson Fernando Muller Guzzo
- Postgraduate Program in Biological Sciences, Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Silvia Elisandra Bitello Nunes
- Postgraduate Program in Biological Sciences, Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Rafael Bremm Padilha
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Amanda Muliterno Domingues
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Brayan Braz Barbosa
- Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Ionara Rodrigues Siqueira
- Postgraduate Program in Biological Sciences, Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil; Postgraduate Program in Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil
| | - Adriana Simon Coitinho
- Postgraduate Program in Biological Sciences, Physiology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil; Postgraduate Program in Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil; Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, Porto Alegre, RS, Brazil.
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Jia Y, Tang L, Yao Y, Zhuo L, Qu D, Chen X, Ji Y, Tao J, Zhu Y. Low-intensity exercise combined with sodium valproate attenuates kainic acid-induced seizures and associated co-morbidities by inhibiting NF-κB signaling in mice. Front Neurol 2022; 13:993405. [PMID: 36212646 PMCID: PMC9534325 DOI: 10.3389/fneur.2022.993405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Sodium valproate (VPA) is a broad-spectrum anticonvulsant that is effective both in adults and children suffering from epilepsy, but it causes psychiatric and behavioral side effects in patients with epilepsy. In addition, 30% of patients with epilepsy develop resistance to VPA. At present, regular physical exercise has shown many benefits and has become an effective complementary therapy for various brain diseases, including epilepsy. Therefore, we wondered whether VPA combined with exercise would be more effective in the treatment of seizures and associated co-morbidities. Here, we used a mouse model with kainic acid (KA)-induced epilepsy to compare the seizure status and the levels of related co-morbidities, such as cognition, depression, anxiety, and movement disorders, in each group using animal behavioral experiment and local field potential recordings. Subsequently, we investigated the mechanism behind this phenomenon by immunological means. Our results showed that low-intensity exercise combined with VPA reduced seizures and associated co-morbidities. This phenomenon seems to be related to the Toll-like receptor 4, activation of the nuclear factor kappa B (NF-κB), and release of interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), and IL-6. In brief, low-intensity exercise combined with VPA enhanced the downregulation of NF-κB-related inflammatory response, thereby alleviating the seizures, and associated co-morbidities.
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Affiliation(s)
- Yuxiang Jia
- School of Medicine, Shanghai University, Shanghai, China
| | - Lele Tang
- Department of Neurology and Neurosurgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Yao
- School of Medicine, Shanghai University, Shanghai, China
| | - Limin Zhuo
- School of Medicine, Shanghai University, Shanghai, China
| | - Dongxiao Qu
- Department of Neurology and Neurosurgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xingxing Chen
- Department of Neurology and Neurosurgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yonghua Ji
- School of Medicine, Shanghai University, Shanghai, China
- *Correspondence: Yonghua Ji
| | - Jie Tao
- Department of Neurology and Neurosurgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jie Tao
| | - Yudan Zhu
- Department of Neurology and Neurosurgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yudan Zhu
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Arida RM, Sales EPDN, Teixeira-Machado L, Prado GFD, Gutierre RC, Carrizosa J. Neurologists' knowledge of and attitudes toward physical exercise for people with epilepsy in Latin America. Epilepsy Behav 2022; 131:108705. [PMID: 35526463 DOI: 10.1016/j.yebeh.2022.108705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the favorable effects of exercise in people with epilepsy (PWE), the lower participation in physical/sports activities may be partly due to inadequate knowledge and attitudes of health professional about their benefits. In this regard, in 2016, the International League Against Epilepsy (ILAE) through its Task Force on Sports and Epilepsy published a consensus paper that provided general guidance concerning participation in exercise/sport activities for PWE. We investigated views and attitudes toward physical exercise practice among neurologists in Latin America. METHODS A 22-item cross-sectional online questionnaire-based study among neurologists included the following: (1) profile of participating neurologists, (2) doctors' attitudes and perceptions about physical/sport activities for PWE, and (3) neurologist experience concerning patient's report about their involvement in physical/sport activities. RESULTS In total, 215 of 519 neurologists from 16 different countries returned the questionnaire. Although about one-third of neurologists had no information about the effect of exercise on epilepsy, and 60% of them did not know the published recommendations of the ILAE Task Force on Sports and Epilepsy, the majority (92.5%) advised the practice of exercise, were aware of sport activities for their patients and agreed that exercise can reduce comorbidities associated with epilepsy (X2 = 249.34; p < 0.001). Most of the neurologists did not believe that exercise is a seizure-inducing factor, but more than half would restrict their patients with uncontrolled seizures for exercise practice (X2 = 250.77; p < 0.001). Most barriers considered by PWE in the past, currently are not viewed by neurologists and their patients (X2 = 249.34; p < 0.001). CONCLUSION While this study reveals that neurologists have some knowledge gaps in attitudes toward physical exercise for PWE, encouraging attitudes were observed by neurologists. Considering that physicians can impact on patient confidence and decision, a better communication between neurologists and their patients concerning the benefits of exercise can increase PWE participation in physical/sports activities. To improve this scenario, more efforts should be made to increase the neurologists' knowledge and perceptions on this issue.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | - Jaime Carrizosa
- Pediatric Department Child Neurology Service, University of Antioquia, Medellín, Colombia
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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A 10-day mild treadmill exercise performed before an epileptic seizure alleviates oxidative injury in the skeletal muscle and brain tissues of the rats. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1056192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Arida RM, Passos AA, Graciani AL, Brogin JAF, Ribeiro MDAL, Faber J, Gutierre RC, Teixeira-Machado L. The Potential Role of Previous Physical Exercise Program to Reduce Seizure Susceptibility: A Systematic Review and Meta-Analysis of Animal Studies. Front Neurol 2021; 12:771123. [PMID: 34956052 PMCID: PMC8702853 DOI: 10.3389/fneur.2021.771123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/26/2021] [Indexed: 12/09/2022] Open
Abstract
Background: Clinical and pre-clinical studies indicate a reduction in seizure frequency as well as a decrease in susceptibility to subsequently evoked seizures after physical exercise programs. In contrast to the influence of exercise after epilepsy previously established, various studies have been conducted attempting to investigate whether physical activity reduces brain susceptibility to seizures or prevents epilepsy. We report a systematic review and meta-analysis of different animal models that addressed the impact of previous physical exercise programs to reduce seizure susceptibility. Methods: We included animal model (rats and mice) studies before brain insult that reported physical exercise programs compared with other interventions (sham, control, or naïve). We excluded studies that investigated animal models after brain insult, associated with supplement nutrition or drugs, that did not address epilepsy or seizure susceptibility, ex vivo studies, in vitro studies, studies in humans, or in silico studies. Electronic searches were performed in the MEDLINE (PubMed), Web of Science (WOS), Scopus, PsycINFO, Scientific Electronic Library Online (SciELO) databases, and gray literature, without restrictions to the year or language of publication. We used SYRCLE's risk of bias tool and CAMARADES checklist for study quality. We performed a synthesis of results for different types of exercise and susceptibility to seizures by random-effects meta-analysis. Results: Fifteen studies were included in the final analysis (543 animals), 13 of them used male animals, and Wistar rats were the most commonly studied species used in the studies (355 animals). The chemoconvulsants used in the selected studies were pentylenetetrazol, penicillin, kainic acid, pilocarpine, and homocysteine. We assessed the impact of study design characteristics and the reporting of mitigations to reduce the risk of bias. We calculated a standardized mean difference effect size for each comparison and performed a random-effects meta-analysis. The meta-analysis included behavioral analysis (latency to seizure onset, n = 6 and intensity of motor signals, n = 3) and electrophysiological analysis (spikes/min, n = 4, and amplitude, n = 6). The overall effect size observed in physical exercise compared to controls for latency to seizure onset was −130.98 [95% CI: −203.47, −58.49] (seconds) and the intensity of motor signals was −0.40 [95% CI: −1.19, 0.40] (on a scale from 0 to 5). The largest effects were observed in electrophysiological analysis for spikes/min with −26.96 [95% CI: −39.56, −14.36], and for spike amplitude (μV) with −282.64 [95% CI: −466.81, −98.47]. Discussion:Limitations of evidence. A higher number of animal models should be employed for analyzing the influence of exerciseon seizure susceptibility. The high heterogeneity in our meta-analysis is attributable to various factors, including the number of animals used in each study and the limited number of similar studies. Interpretation. Studies selected in this systematic review and meta-analysis suggest that previous physical exercise programs can reduce some of the main features related to seizure susceptibility [latency seizure onset, spikes/min, and spike amplitude (μV)] induced by the administration of different chemoconvulsants. Systematic Review Registration: PROSPERO, identifier CRD42021251949; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251949.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Jean Faber
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Åkerlund S, Varkey E, Klecki J, Zelano J, Ben-Menachem E. Randomized controlled trial of moderate cardiovascular exercise for patients with drug-resistant epilepsy. Epilepsy Behav 2021; 124:108335. [PMID: 34601232 DOI: 10.1016/j.yebeh.2021.108335] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The primary research question of this study was whether a moderate cardiovascular exercise program can reduce seizure frequency in patients with focal drug-resistant epilepsy (DRE). The hypothesis is that cardiovascular fitness will reduce seizure frequency in persons with epilepsy (PWE). METHODS Twenty-eight patients were randomized into two groups; exercise or relaxation. The exercise group were given an ergometric bicycle sent to their home to be used for 150 min/week, 30 min/day for 5 days a week for the study period of 6 months. Participants in the relaxation group were given audio muscular relaxation exercises to be performed for 20 min at least five times per week for the study period of 6 months. Seizure counts and exercise/relaxation sessions were registered daily in a written diary. Both groups received monthly motivational telephone calls. Seizures, anxiety, and depression symptom ratings (Hospital Anxiety and Depression Scale (HADS)), health status ratings (RAND-36), aerobic capacity (estimated VO2max), self-efficacy for exercise (SEE), level of physical activity, and adverse events were measured at the baseline and after the 6 months of intervention. CONSORT guidelines were followed. RESULTS Twenty-two patients completed the intervention. There were no significant changes in seizure frequency in either of the groups. Six months of moderate exercise did increase the level of physical activity and maximal oxygen uptake. SIGNIFICANCE Moderate exercise did not affect seizure frequency in this study. The patients in the exercise group did increase their estimated VO2max, which is an important indicator for health, without deterioration of seizure frequency. This was accomplished with only minimal support from a physiotherapist every month. To exercise at home at a moderate intensity level with regular support may therefore be an option for patients with epilepsy. The patients in the exercise group increased their level of physical activity significantly, which indicates that they were compliant to the treatment.
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Affiliation(s)
- Sara Åkerlund
- Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Occupational and Physiotherapy, Gothenburg, Sweden; Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emma Varkey
- Region Västra Götaland, Sahlgrenska University Hospital/Östra, Department of Occupational and Physiotherapy, Gothenburg, Sweden; Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Judith Klecki
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Elinor Ben-Menachem
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden.
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Danti FR, Invernizzi F, Moroni I, Garavaglia B, Nardocci N, Zorzi G. Pediatric Paroxysmal Exercise-Induced Neurological Symptoms: Clinical Spectrum and Diagnostic Algorithm. Front Neurol 2021; 12:658178. [PMID: 34140924 PMCID: PMC8203909 DOI: 10.3389/fneur.2021.658178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022] Open
Abstract
Paroxysmal exercise-induced neurological symptoms (PENS) encompass a wide spectrum of clinical phenomena commonly presenting during childhood and characteristically elicited by physical exercise. Interestingly, few shared pathogenetic mechanisms have been identified beyond the well-known entity of paroxysmal exercise-induced dyskinesia, PENS could be part of more complex phenotypes including neuromuscular, neurodegenerative, and neurometabolic disease, epilepsies, and psychogenetic disorders. The wide and partially overlapping phenotypes and the genetic heterogeneity make the differential diagnosis frequently difficult and delayed; however, since some of these disorders may be treatable, a prompt diagnosis is mandatory. Therefore, an accurate characterization of these symptoms is pivotal for orienting more targeted biochemical, radiological, neurophysiological, and genetic investigations and finally treatment. In this article, we review the clinical, genetic, pathophysiologic, and therapeutic landscape of paroxysmal exercise induced neurological symptoms, focusing on phenomenology and differential diagnosis.
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Affiliation(s)
- Federica Rachele Danti
- Unit of Child Neurology, Department of Pediatric Neuroscience, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federica Invernizzi
- Unit of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico C. Besta, Milan, Italy
| | - Isabella Moroni
- Unit of Child Neurology, Department of Pediatric Neuroscience, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Barbara Garavaglia
- Unit of Medical Genetics and Neurogenetics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico C. Besta, Milan, Italy
| | - Nardo Nardocci
- Unit of Child Neurology, Department of Pediatric Neuroscience, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanna Zorzi
- Unit of Child Neurology, Department of Pediatric Neuroscience, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
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Evidences for a Role of Gut Microbiota in Pathogenesis and Management of Epilepsy. Int J Mol Sci 2021; 22:ijms22115576. [PMID: 34070389 PMCID: PMC8197531 DOI: 10.3390/ijms22115576] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Epilepsy as a chronic neurological disorder is characterized by recurrent, unprovoked epileptic seizures. In about half of the people who suffer from epilepsy, the root cause of the disorder is unknown. In the other cases, different factors can cause the onset of epilepsy. In recent years, the role of gut microbiota has been recognized in many neurological disorders, including epilepsy. These data are based on studies of the gut microbiota–brain axis, a relationship starting by a dysbiosis followed by an alteration of brain functions. Interestingly, epileptic patients may show signs of dysbiosis, therefore the normalization of the gut microbiota may lead to improvement of epilepsy and to greater efficacy of anticonvulsant drugs. In this descriptive review, we analyze the evidences for the role of gut microbiota in epilepsy and hypothesize a mechanism of action of these microorganisms in the pathogenesis and treatment of the disease. Human studies revealed an increased prevalence of Firmicutes in patients with refractory epilepsy. Exposure to various compounds can change microbiota composition, decreasing or exacerbating epileptic seizures. These include antibiotics, epileptic drugs, probiotics and ketogenic diet. Finally, we hypothesize that physical activity may play a role in epilepsy through the modulation of the gut microbiota.
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