204 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
a. Frequency of seizures and adequacy of control
b. Effects of medications that might impact perform-
ance of safety
c. Activity or sport being considered for participation
d. Readiness or desire by athlete to participate in a
specific sport or activity- Athletes with epileptic triggers should understand that
participation in activities that might initiate seizures
should be avoided. Specific instances would include
hyperventilation brought on by running or fatigue
caused by prolonged athletic activities. - While participation in water sports would appear to be
a danger to any athlete with epilepsy, the fact that most
competitive swimming competitions are observed by
not only parents but coaches and trainers significantly
reduces the inherent risk. - Contraindications for swimming are small:
a. Seizures have occurred recently or are poorly con-
trolled.
b. Medications have recently been changed or the
patient is noncompliant.
c. Antiepileptic drug(AED) blood levels are unstable.
d. Lack of one-on-one supervision during the event.
e. Lake or murky water events, including all pro-
longed underwater events. - Scuba diving and underwater swimming would
include a restricted ability to observe any seizure activ-
ity and the increased risk would need to be factored in
to any decision regarding participation. - Gymnastic events requiring a significant amount of
swinging or separation from equipment at any height
would pose an increased risk of falls and subsequent
trauma. The presence of coaches and observers would
provide little protection from injury because of an
inability to be within reach of a falling athlete. The
use of safety harnesses and direct contact observers
for those athletes with epilepsy may be required for
participation. - If a seizure does occur during a sporting event, further
participation should be restricted because of potential
post-ictal effects. Special consideration could be
made for the athlete who experiences an absence type
event with minimal residual effects. - The appropriate categorization of the seizure type and
epileptic syndrome is the most important criterion in
deciding on medical treatment.
MEDICAL TREATMENT OF EPILEPSY
- The medical treatment of epilepsy is a difficult task
for the physician working with athletes. While the
older antiepileptic medications are conveniently for-
mulated for once or twice daily regimens, thereby
improving compliance, they also have more signifi-
cant side effects that may impact on an athlete’s per-
formance capability.- While each medication has specific side effects, only
those that would be considered to have a negative
impact on athletic performance or function will be
discussed. - Phenytoin has been reported to depress cognitive
function, slow overall performance, and produce
sedation (Aubry et al, 2001). - The toxic side effects of carbamazepine include dizzi-
ness, diplopia, sedation, ataxia, and nausea. Also, the
concurrent use of erythromycin may increase carba-
mazepine levels. - The most common side effects of valproate include
weight gain secondary to increased appetite and mild
tremors. In rare cases it can even cause an encephalopa-
thy with sedation and cognitive impairment. - Gabapentin is generally well tolerated with minimal
side effects and has no significant drug interactions.
Since it is not metabolized by the liver, it does not
induce the P-450 enzyme system. - Allergic skin rash is the most common side effect of
lamotrigine, but additional side effects include dizzi-
ness, headaches, diplopia, sedation, and movement
disorders.
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