Physical activity in sudden unexpected death in epilepsy: Much more than a simple sport

Arida RM, Scorza CA, Schmidt B, de Albuquerque M, Cavalheiro EA, and Scorza FA (2008) Physical activity in sudden unexpected death in epilepsy: Much more than a simple sport. Neurosci Bull 24:6 374–80

Abstract: Sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. Additionally, potential pathomechanisms for SUDEP is unknown, but it is very probable that cardiac arrhythmia during and between seizures, electrolyte disturbances, arrhythmogenic drugs or transmission of epileptic activity via the autonomic nervous system to the heart may play a potential role. Quite interestingly, clinical and experimental data have shown that physical activity can decrease seizure frequency, as well as lead to improved cardiovascular health in patients with epilepsy. Based on these facts, the purpose of this article is to review the body of literature of the possible contribution of physical exercise to the SUDEP prevention in a comprehensive manner.

Article

Sudden Unexpected Death in Epilepsy

Epilepsy is one of the most common serious neurological conditions that is associated with a two- to three-fold increase in mortality compared with general population, and sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death. SUDEP is defined as sudden, unexpected, witnessed or unwitnessed, nontraumatic and nondrowning death in patients with epilepsy, with or without evidence of a seizure and excluding documented status epilepticus, in which postmortem examination usually does not reveal a toxicological or anatomical cause of death. Comparisons of incidence estimates for SUDEP are difficult, since different definitions of SUDEP have been used, not all patients have postmortem examination, and case ascertainment methods and source populations are varied. SUDEP is responsible for 7.5% to 17% of all deaths in epilepsy and has an incidence of 1:500 and 1:1 000 among adults. Information concerning risk factors for SUDEP is conflicting, but potential risk factors include age, early onset of epilepsy, duration of epilepsy, uncontrolled seizures, mainly in the temporal lobe epilepsy, seizure frequency, seizure type, number of antiepileptic drugs and winter temperatures. Additionally, potential pathomechanisms for SUDEP is unknown, but it is very probable that cardiac arrhythmia during and between seizures, electrolyte disturbances, arrhythmogenic drugs or transmission of epileptic activity via the autonomic nervous system to the heart play potential roles.

We have to keep in mind that preventative measures other than medical and surgical therapies could be much more useful in the prevention of SUDEP. Among these factors, physical activity may play an interesting role. Substantial evidence from animal and clinical studies indicated that physical activity could reduce seizure frequency, as well as lead to improved cardiovascular and psychological health in patients with epilepsy. Based on these facts, the aim of this article is to review the body of literature of the possible contribution of physical exercise to the SUDEP prevention in a comprehensive manner.