Epilepsy brain scan
Epilepsy is the most common chronic neurological illness from which, according to the World Health Organization (WHO), suffers around 50 million people. Although the illness is successfully treated today, the affected are still facing discrimination and stigma because of which they oftentimes hide their illness. However, the fact is that the it does not lessen their psycho-physiological abilities or intellectual capacities.

The illness represents a huge socioeconomical burden to the patients, their families and the society as a whole. Because of a certain stigma which has been associated with epilepsy for centuries, patients do not want anybody to know about their condition. Primarily, they fear getting fired at their workplace, not being able to find a job, continuing their education, getting promoted, equally participating in social activities (even sports activities), making new friends, getting married, i.e. an unjust social judgement and all of its consequences.

Shutting people with epilepsy out from the workplace as well as social (sports) activities only makes the illness worse. Such seclusion affects the psychological status of the person, resulting in feelings of turndown, inferiority and, in more difficult cases, a depressive disorder which makes the treatment harder to achieve. In most cases, epilepsy does not affect the person's psycho-physiological or intellectual capacities and, apart from the seizure, you cannot distinguish them from any other healthy individual. It is less known that epileptic seizures can occur in people who do not suffer from epilepsy- around 10% of the world's population will experience this kind of an attack during their lifetime.

Signs of Epilepsy

Also, it is less known that epilepsy manifests in a sequence of symptoms which are rarely recognized, i.e. misdiagnosed and, thus, unsuccessfully treated. The illness is usually linked to the epileptic attack with a loss of consciousness, twitching and convulsions of the body and the appearance of foam (spit) around the mouth. However, in more than a half of epileptic seizures the person does not lose his or her consciousness and the symptoms are various brief disorders of the motor, sensory, visual, hearing, olfactory, taste functions or the function of internal organs (heart, lungs, intestines) along with a swayed or intact awareness. Some of the symptoms can include headaches, dizziness, different hearing, olfactory or taste hallucinations and illusions, disorders of the heart, intestines or various psychological symptoms.

Almost every illness or injury of the brain can cause epilepsy, especially if it leads to the injury of the cerebral cortex. Oftentimes even the most advanced tests and checkups of the brain tissue cannot find the sign of illness. It is believed that, in such a situation, genetic sensibility is the most important and, so, epilepsy can occur in more than one member of the family. Although it can be found, such an occurrence is still relatively small.

It is less known that some important historical figures suffered from epilepsy, even over an extended period of their lives. Some of them live in times when treatment of epilepsy wasn't even remotely as successful as it is today. However, despite their condition, they have achieved breathtaking results during their lives. Some of them are: Socrates, Aristotle, Pythagoras, Alexander the Great, Julius Caesar, Michelangelo, Dante Alighieri, Beethoven, Napoleon Bonaparte, Charles Dickens, Vincent Van Gogh, Sir Isaac Newton, F. M. Dostoevsky, Theodor Roosevelt, Alfred Nobel, Martin Luther King, Agatha Christie, Thomas A. Edison, Richard Burton and many more.

For those who are fans and connoisseurs of martial arts, we can mention even some martial arts masters who had an epileptic attack some time during their lifetime. Some of these famous martial arts masters are: Joe Luis (had an epileptic attack in 1970 along with hallucinations and paranoia), Muhammad Ali (from 2000 to 2016, suffered from a mild form of epilepsy which was linked to his primary condition- Parkinson's disease), André René Roussimoff (André the Giant; in 1992/ 1993 had a mild form of epilepsy caused by his other health conditions, primarily heart disease and congestive heart failure), Shigeru Egami (1980/1981, epilepsy caused by his primary illness- cerebral embolism), Taiji Kase (from 1999 to 2004 had a mild form of epilepsy that was triggered by a heart attack), Bruce Lee (1972/1973, also a mild form of epilepsy which was caused by a cerebral edema, i.e. brain swelling), general Choi Hong Hi (from 2000 to 2002, epilepsy caused by cancer).

The diagnosis of the illness is set based on the symptoms of the attack and the results of the electroencephalogram test (EEG). The doctor is usually not present when the attack occurs and so he or she is in need of a detailed and reliable description of the seizure and the conditions that led to it. Also, it is very important to collect the statements of the witnesses because, often times than not, the person who suffered from the attack fainted and is not able to describe the whole event. In almost all cases it is necessary to make an EEG, a MRI (Magnetic resonance imaging) or a CT scan of the brain, as well as an EKG (Electrocardiogram) and laboratory (blood) tests.

Epilepsy is a disorder which is linked to many different illnesses and conditions. Accordingly, the chances of getting full treatment are very different and depend on specific circumstances which led to epilepsy. However, when analyzing the results of treatment in a large number of adults with various forms of epilepsy, we can say that the attacks occur in 2/3 of patients who take their therapy on a regular basis. When we find ourselves near a person who is having an epileptic attack, we certainly need to help and call emergency (911,or 999,or 112). It is completely wrong to place a person who is having an attack on his or her side or put something into the person's mouth in order not to prevent him or her from biting off his or her tongue, which is often done.

Epilepsy and physical activity

Throughout the past, persons who were suffering from epilepsy, usually without any real scientific grounding, were restricted in terms of physical activities they were allowed to practice. This resulted in epileptic patients to have a worse health condition and form than the general population. People who suffered from epilepsy were prohibited and banned from various forms of activities (mostly because of fear, over-protective behaviour and the lack of knowledge about the condition) up until the 1970's when a change of attitude takes over. There was a study in Sweden in 1974 that, instead of boundaries and limitations, started to encourage the inclusion of patients with epilepsy in physical activities. More recently, in 2014 and 2016, there were a number of studies in different research countres around the world (Sweden, Norway, Germany, Russia, United States of America, Japan, China, Australia) and most doctors agree that regular physical activity in patients with epilepsy could be very beneficial and has a positive outcome because it reduces the number of epileptic seizures in an affected person.

Taekwondo sparring

In 2016 the Internation League Against Epilepsy gave guidelines on the participation of persons who suffer from epilepsy in sports activities. Consequently, sports disciplines are divided into three categories, depending on the potential risk for the affected person. They take into consideration all the important characteristics of epilepsy as an illness. The first category includes physical activities that have no real additional risk, the second category entails activities of a moderate risk and the third includes high- risk activities. The decision to take on a specific sports discipline should be strictly individual. Affected persons should be included into physical activities, but taking into account their safety as well as the safety of others. In today's time, the doctors' (professionals') suggestion is that epileptic patients are able to take up professional as well as amateur sports, across all age groups.

With some exceptions, most sports disciplines are safe for people who suffer from epilepsy, of course, with taking into consideration the adequate control of the epileptic attacks, the intake of medication, i.e. therapy, but also by preparing the family as well as the instructor (trainer) on the potential risks associated with the physical activity. Family doctors, neurologists and paediatricians have to support regular physical activity of their affected patients and inform them about the positive outcomes of physical exercize.

The question that is often asked is can physical activity (especially some martial arts) result in a enlarged number or occurrence of epileptic seizures. Some views on the risks of the occurrence of epileptic attacks during a physical activity are pretty controversial. However, most studies have proven the positive effects of physical activity for the affected persons during exercize, most of them including children and adolescents. Studies have shown that positive effects of exercize include lower frequencies of epileptic attacks, the improvement of the cardiovascular capacity, higher quality of life and self-confidence. Allowing young persons who suffer from epilepsy to take up a physical activity (especially martial arts) can lead to higher social acceptance from their peers and similar age groups. Also, it will most definitely add to their physical and psychosocial development.

Epilepsy is oftentimes a marginalized illness and suffering from it means that you will be treated differently. Because of this, most people who suffer from it don't give away their diagnosis because they believe that it will become an obstacle in taking part in physical activities. Epileptic patients possess a certain fear from a negative reaction when revealing their diagnosis to their instructors as well as other members. They do not want to be different or take on an identity of a "person with epilepsy". In many sports, the person who would reveal its diagnosis noticed that, afterwards, its teamplayers, i.e. other members would become overly worried or didn't want to be in the person's presence. This is exactly why choosing a certain martial art is beneficial in such situations. In martial arts centres, nobody will be too excited or surprised by their choice. In those centres, such persons will not be overly-protected or stigmatized and, in most cases, they will be equal with the other members.

Numerous contemporary studies have proven the positive effects of physical activities, including epileptic persons taking on martial arts. When exercizing a certain martial arts sport or skill, the affected person's aerobic capacities are improved. The decrease in the frequency of the attacks and the increase in self-confidence and social integration occur. Daily exercize and, especially, exercizing certain martial arts or sports can lead to an increase in cognitive functions, no matter the age of the person.

In various clinical studies, physical exercize, especially martial arts (wrestling, judo, karate, tae kwon do, kung fu, tai chi, aikido) are closely linked to better EEG results and the increase of the threshold of another epileptic seizure. It was shown that an attack is unlikely to happen during physical exertion and exhaustion. These changes in affected patients are most relevant for children who suffer from epilepsy and their inclusion into martial arts. In turn, this would greatly reduce their social exclusion to which they oftentimes are fallen victims to.

Unfortunately, there are still many theories which support the prohibition or restriction of epileptic patients taking on a physical activity. The reasons include: the risk of injury in case an epileptic attack happens during the exercize, many factors that can be a cause of the epileptic seizure (excitement, stress, exertion etc.), the risk of aggravation of the consequences of exercize and the possible change in therapy, i.e. the effect of medication on a person during exercize.

Sparring Helmet

Even so, newer scientific papers compliment taking up certain marital arts and sports (judo, ju jutsu, aikido, boxing, tae kwon do, wrestling, fencing, kendo, kickboxing, sanda kung fu, tai chi, capoeira, sambo) among persons who suffer from epilepsy for the following reasons: the risk of injury is lower in comparison to other sports because these disciplines often require the use of protective garments. Also, the exercize alone is performed on a softer surface (mat, tatami). Stress and excitement during the training or competition gradually become controlled and certain smaller, i.e. milder punches given to the affected person in its protective equipment are not enough to bring up an epileptic attack (milder jolts of the head cannot initiate an attack).

During the course of the exercize, the affected person wears equiptment that protects him or her (helmet, shields, pads etc.) and, in the case of an attack, will be completely safe should he/she fall or make a jerk or have a cramp in his/her body. In comparison to other physical activities or sports such as running, walking, hiking, swimming, cycling, basketball, volleyball, horseback riding, rowing, sailing or gymnastics, ice skating or skiing (to name a few), the person should feel very safe and protected.

People who have experienced an epileptic seizure during the course of martial arts or sports training have said that the injuries were usually mild. For example, they have had smaller head or soft tissue injuries. When training martial arts, stress can activate, i.e. stimulate the production of the adrenal hormones as well as neurosteroids which increase the chance for an epileptic seizure. On the other hand, the same stress levels stimulate the production of corticotropin - a hormone that prompts the secretion of deoxycorticosterone in the adrenal gland. Its own production stimulates the secretion of other corticosterones which, furthermore, synthetize in the liver and brain. During this process, they activate receptors in certain parts of the brain and, thus, lower the probability of an epileptic attack. This proves that certain stress as well as excitement can have a positive effect for the patient during and after the course of physical exercize.

Also, it has been proven that martial arts training leads to the increase of the metabolic rates of liver enzymes which, in turn, increases the metabolism of some antiepileptic drugs, especially among elderly patients. Although some experts have claimed that certain aerobic activity led to seizures, it has been proven to be wrong. Additionally, epileptic patients know themselves and their bodies best and can most often recognize if a given activity can lead to an attack. There has been a research among patients who suffer from epilepsy conducted in Norway in 2014. It made them do a physical activity of maximum intensity and none of the subjects suffered from an epileptic attack. This has proved that epileptic patients could take on martial arts and sports such as karate, boxing, muay thai, judo, wrestling, ju jutsu, tae kwon do, krav maga, kung fu, MMA (UFC) as well as some other more exhausting martial arts and sports.

Martial arts sword

It has been proven that patients who have trained martial arts showed a much lower level of depression depending on factors such as age, sex, frequency of attacks (the type of epilepsy) and the level of stress in one's life. It seems that depression plays a central role in the connection between stress and anxiety as it changes the frequency of the attacks. There are even proofs that patients who suffer from epilepsy who train some of the martial arts on a regular basis cope much better with stressful situations. In turn, this minimizes the attacks that are initiated by psychological stress. It is extremely important to suggest a regular and adequate type of physical activity to persons who suffer from epilepsy in order to prevent or cure depression. For the same reason, martial arts training has a significant advantage in comparison to other physical activities.

As well as among healthy individuals, martial arts training leads to weight loss, reduction of fat, reduction of risk factors that are connected to diabetes, hypertension and coronary disease. Taking certain medication to cure epilepsy can lead to a metabolic disorder of vitamine D and, consequently, osteoporosis and fractures among the affected patients. It is well known that martial arts training leads to osteoprotection, especially in adolescent age and postmenopause.

It is of utmost importance that the affected patient is approached individually and that his or her individual benefits are evaluated. Also, specialists should determine the risk of taking on a certain martial art or sport. The type of epilepsy, frequency of attacks, their causes, the period in which they occur as well as the part of the day in which they happen should all be taken into consideration. Apart from that, the effect of the medications and their regularity should also be taken into account. Persons who haven't had an epileptic attack in 12 months are clear to take part in all martial arts disciplines. Also, persons with epilepsy who have an attack only while sleeping can take on a martial arts sport as soon as they want. Patients that believe that their epilepsy has been cured have had an attack depending on their age. That means that the last attack must have occurred in more than 5 or 10 years ago are they do not take medication anymore. They are free to start training martial arts or sports right away.

Special attention needs to be directed towards children and adolescents. Sport and physical activity are an essential part of childhood and, in case they are taken away from them, they might have a sense of separation and will probably feel different from their peers. Also, children who do not take on any sports in their childhood won't do so in their adult life as well. This is why martial arts is an ideal choice for affected children to train self-control, increase their self-confidence and, consequently, their motivation to exercize.

Family doctors, neurologists and paediatricians have to support patients that suffer from epilepsy in training martial arts. Also, they need to make them aware of safety measures that go hand in and with the sage of protective equipment. Their efforts need to be directed towards lowering the level of stigma in order to increase their overall quality of life.

Every person is responsible for themselves and their behavior, as well as his/her health. This is especially true for any adult who is suffering from an illness. Doctors as well as martial arts trainers need to know how to protect children who suffer from a disease because they are not aware of a certain risk and they cannot predict it. This is why choosing martial arts in addition to repeated and regular usage of protective equipment during training is an excellent choice for patients who suffer from epilepsy.

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