Kamel JT, Badawy RAB, Cook MJ. Exercise-induced seizures and lateral asymmetry in patients with temporal lobe epilepsy.
EPILEPSY & BEHAVIOR CASE REPORTS 2014;
2:26-30. [PMID:
25667863 PMCID:
PMC4308088 DOI:
10.1016/j.ebcr.2013.12.004]
[Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
Abstract
Objective
The objective of this case report is to better characterize the clinical features and potential pathophysiological mechanisms of exercise-induced seizures.
Methods
We report a case series of ten patients from a tertiary epilepsy center, where a clear history was obtained of physical exercise as a reproducible trigger for seizures.
Results
The precipitating type of exercise was quite specific for each patient, and various forms of exercise are described including running, swimming, playing netball, dancing, cycling, weight lifting, and martial arts. The level of physical exertion also correlated with the likelihood of seizure occurrence. All ten patients had temporal lobe abnormalities, with nine of the ten patients having isolated temporal lobe epilepsies, as supported by seizure semiology, EEG recordings, and both structural and functional imaging. Nine of the ten patients had seizures that were lateralized to the left (dominant) hemisphere. Five patients underwent surgical resection, with no successful long-term postoperative outcomes.
Conclusions
Exercise may be an underrecognized form of reflex epilepsy, which tended to be refractory to both medical and surgical interventions in our patients. Almost all patients in our cohort had seizures localizing to the left temporal lobe. We discuss potential mechanisms by which exercise may precipitate seizures, and its relevance regarding our understanding of temporal lobe epilepsy and lateralization of seizures. Recognition of, as well as advice regarding avoidance of, known triggers forms an important part of management of these patients.
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