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Seizures in Athletes

Seizures in Athletes. Kevin deWeber, MD, FAAFP Director, Sports Medicine Fellowship USUHS. Objectives. Refresh your knowledge of seizures Types Etiology Initial Evaluation Treatments Discuss clearance considerations for athletes with epilepsy. Definition.

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Seizures in Athletes

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  1. Seizures in Athletes Kevin deWeber, MD, FAAFP Director, Sports Medicine Fellowship USUHS

  2. Objectives • Refresh your knowledge of seizures • Types • Etiology • Initial Evaluation • Treatments • Discuss clearance considerations for athletes with epilepsy

  3. Definition • SEIZURE: an abnormal electrical discharge of cortical neurons leading to sudden involuntary alteration in movement, perception , or behavior. • EPILEPSY: a disorder of recurrent seizures

  4. Partial seizures Localize in specific part of the brain SIMPLE: no altered MS Limb twitch Sensory disturbance Psychic symptoms COMPLEX: involves impaired consciousness Can become generalized Generalized seizures Bilateral cortical discharge COMPLEX in nature (impaired level of consciousness) Tonic-clonic Myoclonic Atonic Absence Seizure classification

  5. Seizure Etiology • Idiopathic (epilepsy) • Trauma (concussion, hemorrhage) • Heat illness • Electrolyte abnormalities (Na) • Toxins (Etoh, drugs, meds) • Mass lesions • Metabolic disorders • Cerebral ischemia (gas embolism, stroke) • Infection

  6. Seizure first aid • Monitor ABC’s • Remove from any dangerous settings • Clear objects away to prevent injury • Monitor seizure closely • Onset time, initial manifestation/aura, altered LOC, cyanosis, automatic activities, tongue biting, incontinence, duration • If longer than 10 minutes  STATUS EPILECTICUS

  7. Additional pre-hospital eval • Check blood glucose • Check core temp • Monitor Pox, VS • Review medical hx for possible clues • Start IV if status epilepticus

  8. Status Epilepticus • Seizure > 10 min, or recurrent seizures >30 min w/o full recovery • Immediate treatment is needed to prevent serious sequelae • Anoxic brain injury • IC hemorrhage • Cardiopulmonary arrest • Renal failure • Hyperthermia • Aspiration pneumonia • Death

  9. IF no IV access: Rectal diazepam in children Sublingual lorzezpam IM midazolam IM fosphenytoin IV access ready: IV lorazepam bolus If persists >5min: IV fosphenytoin AND phenytoin If persists: ICU admin, induce coma, add IV short-acting drug (midazolam, thiopental, propofol) Status Epilepticus

  10. Case study: 16 yo softball player is at tournament all day, very hot out, got home at 2200 hrs, has seizure, rushed to ED.

  11. Evaluation after first seizure • Chem 20, CBC, ammonia • Drug screen, Etoh level • CT in ER, if negative f/u with MRI • Refer for EEG • If w/u negative for underlying cause: • No treatment needed • Observation indicated • Recurrent rate about 20%  epilepsy

  12. Athletes with Epilepsy • Become familiar with the seizures • Type • Frequency • Known precipitants • Medications and compliance • Adequacy of control

  13. Clearance Concepts • Sad fact: only 5% of epileptics participate in regular physical activity • Happy facts • Exercise improves seizure control • Exercise improves psych well-being, socialization • Encourage participation in epileptics!

  14. Clearance Concepts • Well-controlled seizures: very few contra-indicated sports • Benefits outweigh small risk • Poorly-controlled seizures: be cautious • Individualize decisions

  15. Individualizing Clearance for Athletes with Epilepsy • How good is seizure control? • Poorly controlled: >1/year • Controlled but actively treated • Resolved; no treatment • What risk will this sport pose to the athlete if a seizure occurs? • What risk will this sport pose to OTHERS if a seizure occurs? • What can be done to prevent seizure occurrence?

  16. Clearance Decisions • Aerobic sports: OK • Consider headgear for skiing and skating • Contact sports • Controlled: OK • Poorly controlled: individualize decision Epilepsy and athletics. Clin Sports Med 2003;22(3)

  17. Clearance Decisions • Water sports--OK with caveats: • Provide visual supervision • No open-water swimming • Boating with floatation device • SCUBA diving: prohibited if active X

  18. Clearance Decisions • Sports at heights • Sky diving, hang gliding, rock climbing: • Discouraged if controlled • Prohibited if poorly controlled • Gymnastics: • OK if controlled • Discourage parallel bars & acrobatics if poorly controlled • Diving: prohibited • Equestrian: • OK if controlled • Discouraged if poorly controlled Epilepsy and athletics. Clin Sports Med 2003;22(3)

  19. Clearance Decisions • Motor sports: Prohibited, unless no szrs >2yrs and eligible for drivers license • Wheeled sports (e.g. wheelchair) • OK if Controlled • Prohibited if poorly controlled • Shooting sports • Individualize based on szr type & frequency, and type of weapon used Epilepsy and athletics. Clin Sports Med 2003;22(3)

  20. Clearance Decisions • Sports involving repetitive blows to the head • Boxing, martial arts • No evidence of further seizure risk • Individualize

  21. Preventing Seizures • Avoid precipitants • Dehydration • Extremes of heat/cold • Fatigue & sleep deprivation • Hyperventilation • Hypoxia • Hypoglycemia

  22. Anti-epileptic medications • Many are sedating • Caution in risky sports • May decrease coordination • Follow levels if appropriate

  23. Summary of key points • Exercise improves seizure control and should be encouraged • Well-controlled epileptics have very few contra-indicated sports • SCUBA, diving • Poorly-controlled (>1 szr/yr): fall, shooting & collision sports discouraged

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