Bial, Eisai, GlaxoSmithKline, Janssen-Cilag, Novartis, Pfizer, Sanofi-Aventis, UCB, the Netherlands Epilepsy Foundation, and Stockholm County Council.

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EpilepsySummary: Purpo.se: To compare the exercise habits in a sample of adult outpatients with epilepsy with those of a general population of the same age and sex and furthermore to m d y physical exercise as a seizure precipitant and the risk of sustaining seizure-related injuries while exercising.Metlzods; Two hundred four adult outpatients with active epilepsy responded to two questionnaires. The first one, addressing exercise habits, was a selected part of a broad selfassessing screening used every second year by a marketing and media research institute to reveal changes in the average Norwegian's lifestyle. The exercise habits of the epilepsy population were compared with those of the average population. The other questionnaire, addressing seizures and injuries related to physical exercise, consisted of eight sections and was developed at the National Center for Epilepsy in Norway.Results: The portion of those never exercising was significantly higher among the patient group compared with the average population. Otherwise, the exercise patterns were very similar in the two populations. However, the patients exercised more often in fitness centers and together with friends, whereas individual activities like skiing and swimming were more often preferred by the average Norwegian. Of the 204 patients, 53 and 63% had never experienced seizures during or immediately after exercise, respectively. About 10% of the patients claimed that they had seizures quite often in connection with exercise. However, only 2% had genuine exercise-induced seizures. here arbitrarily defined as having seizures in >SO% of the training sessions. Among those prone to have exercise-related seimres. there was a predominance of patients with symptomatic localization-related epilepsy (i.e., with an underlying structural brain lesion). Most exercise-related seizures occurred during strenuous activity. About 38% of the patients claimed to have personal experience regarding whether regular physical exercise influenced their seizure disorder; of these, S3% claimed there was no influence, 36% claimed there was ;I positive influence. and 10% reported a negative influence. Thirty-six percent of the patients had experienced injuries in connection with physical exercise, but in only 10% were these injuries associated with seizures. The injuries were mostly mild.Conclusions: The surveyed >ample of epilepsy outpatients was more active than expected, and their exercise pattern closely resembled that of the average Norwegian population. In the majority of the patients, physical exercise had no adverse effects, and a considerable proportion (36%) claimed that regular exercise contributed to better seizure control. However. in -10%) of the patients, exercise appeared to be a seizure precipitant, and this applied particularly to those with symptomatic partial epilepsy. The risk of sustaining serious seizure-related injuries exercising seemed modest.

Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3-7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure-influencing factors were kept as constant as possible. Self-reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow-up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life-style change and that continued physical exercise for these patients requires a well-organized and supportive program, requiring experienced and dedicated instructors.

SUMMARYObjective: Epilepsy represents a substantial personal and social burden worldwide. When addressing the multifaceted issues of epilepsy care, updated epidemiologic studies using recent guidelines are essential. The aim of this study was to find the prevalence and causes of epilepsy in a representative Norwegian county, implementing the new guidelines and terminology suggested by the International League Against Epilepsy (ILAE). Methods: Included in the study were all patients from Buskerud County in Norway with a diagnosis of epilepsy at Drammen Hospital and the National Center for Epilepsy at Oslo University Hospital. The study period was 1999-2014. Patients with active epilepsy were identified through a systematic review of medical records, containing information about case history, electroencephalography (EEG), cerebral magnetic resonance imaging (MRI), genetic tests, blood samples, treatment, and other investigations. Epilepsies were classified according to the revised terminology suggested by the ILAE in 2010. Results: In a population of 272,228 inhabitants, 1,771 persons had active epilepsy. Point prevalence on January 1, 2014 was 0.65%. Of the subjects registered with a diagnostic code of epilepsy, 20% did not fulfill the ILAE criteria of the diagnosis. Epilepsy etiology was structural-metabolic in 43%, genetic/presumed genetic in 20%, and unknown in 32%. Due to lack of information, etiology could not be determined in 4%. Significance: Epilepsy is a common disorder, affecting 0.65% of the subjects in this cohort. Every fifth subject registered with a diagnosis of epilepsy was misdiagnosed. In those with a reliable epilepsy diagnosis, every third patient had an unknown etiology. Future advances in genetic research will probably lead to an increased identification of genetic and hopefully treatable causes of epilepsy.

Twenty-one adult in-patients (11 women, 10 men, aged 18-39 years) with uncontrolled epilepsy participated in a 4-week intensive physical training program, exercising for at least 45 min three times a day, 6 days a week, at an intensity of minimum 60% of maximum oxygen uptake (maximum VO2). The program induced a considerable increase in maximum VO2 (mean 19%). Beneficial psychological and social effects were also recorded. The average seizure frequency during the 4-week exercise period was compared with 2 preexercise and 2 postexercise weeks. There was no significant difference, but there was considerable variation among patients. Only six patients had seizures during exercise. The occurrence had no relation to seizure type, mode of activity, or pulse rate. We conclude that physical activity does not represent an important seizure-inducing factor in general, and that in most people with epilepsy physical training appears to have a favorable influence. The exact mechanism behind this influence is not known, but physiologic as well as psychological and social effects may be of importance. Physical training did not change the serum levels of the antiepileptic drugs to a clinically important degree.

A prospective study on seizure-related injuries in Norway's two nursing homes for persons with epilepsy was conducted. Sixty-two multihandicapped patients with mostly difficult-to-treat epilepsy were assessed for 13 months: 6,889 seizures, 2,696 with ensuing falls, resulted in 80 injuries. The seizure-related injury risk was 1.2%. The most frequent injuries were mild soft tissue injuries with and without cuts. Six serious injuries were recorded: two leg fractures, one mandibular fracture, one neck of the femur fracture, one skull fracture, and one subdural hematoma. A 71-year-old woman with subdural hematoma died during operation for the hematoma. Seizure types most often causing injury were atonic and tonic-clonic seizures. Prophylactic measures can be taken. Because the seizure-induced injury risk was slight, we concluded that even persons with refractory epilepsy should be encouraged to lead active lives.