Научная статья на английском языке из журнала "Астана медициналы? журналы", специальный выпуск №4/2015 

I.Sitnikov2, G.Esimova 2, N.Mikhailova 2 , N.Djainakbaev 1, S.Savinov 2, R.Abedimova1, Y.Akchurina 1, I.Bondareva 2, Z.Utebekov 2, T.Sinitcina 2

1 Kazakh-Russian Medical University (Almaty)

2 SVS Laboratory of epilepsy, convulsive diseases research and family monitoring named after V.M. Savinov (Almaty)

THE INFLUENCE OF PHYSICAL ACTIVITY ON PATIENTS WITH EPILEPSY

Abstract

The doctors of SVS Laboratory of epilepsy, convulsive states and family monitoring named after V.M.Savinov (Almaty) have carried on a medical study of a group of patients with various forms of epilepsy, of different ages, under moderate exercise conditions using a veloergometer. By studying an impact of physical activity on the EEG, carrying on a number of surveys before and after exercise to avoid somatic pathologies, performing analysis of changes in the concentration of antiepileptic drugs in blood, evaluating changes in the ECG and blood pressure, as well as an overall emotional status and social activities of patients, we tried to see the relationship between epilepsy and sports.

Key words: epilepsy, veloergometry, physical exercise, electroencephalography (EEG).

ACTUALITY

Currently, there is a very few sources of literature that have a clinical description of cases of how an exercise affect patients with epilepsy. At the same time, there exists an opinion that people suffering from this disease should not do sport activities, thereby restricting themselves in their rights and opportunities.

After a survey of 1,000 patients of different age groups with intact intellect had been conducted, we found out that district neurologists and therapists banned sports and other physical activities to 895 of them.

We have analyzed the available literature data on the pathogenesis of epilepsy, activity of the organism and the nerve cell, and by means of veloergometry and

simultaneous long-term video EEG monitoring assessed an impact of physical activity on patients with epilepsy who are in remission. This research should undoubtedly contribute to the process of social and medical adaptation of patients with epilepsy.

Main Part

Definition of Epilepsy Epilepsy is a chronic brain disease manifested by repeated non-induced attacks with disturbances in motor, sensory, vegetative, cognitive, mental functions caused by excessive neuronal discharges in the gray matter of the cerebral cortex [1,2,4,5,7-12]. Morphofunctional Disorders in Epilepsy. Although manifestations of epilepsy are quite different, all forms of the disease is characterized by disturbances in neuronal activity. An external trigger can often be identified, however usually a reason is a spontaneous activity of neurons. Now it is commonly assumed that instability of levels of endogenous cerebral neurotransmitters provides the basis for most forms of epilepsy. The activity of neurons coordinates a balance between inhibitory (mainly GABA) and excitatory amino acids – glutamate and aspartate. When excitation processes intensify extremely with respect to inhibition, the activity of neurons becomes uncontrollable. As a result, a convulsive attack is developed [9].

In the nervous tissue covered by epileptic activity there occurs a complex ion exchange process when neurons lose potassium ions, and glia accumulates it, sodium ions penetrate into neurons, causing a nerve cell edema. To prevent it, a high level of energy processes, i.e. a high level of ATP reproduction and potassium reserves [9] is required. Biochemical Changes in the Body during Exercise. During muscular activity energy exchange is intensified in the brain, which is expressed in increased consumption of glucose and oxygen. If the load is moderate, it does not cause disturbances in the nerve cells functioning and with the right restitution regime after exercises it does not harm the brain [3].

Besides, reduction of corporal blood circulation inevitably leads to a decrease in cerebral oxygenation. Subsequently, chronic hypoxia and decreased ATP synthesis will develop in future [6].

At the same time, any additional load on the untrained body dramatically increases the consumption of glucose and oxygen, increases a glycogen and phospholipid turnover rate, intensifies a protein breakdown, and contributes to the accumulation of ammonia, as well as other underoxidized amino acids and fats, which in turn increases a risk of paroxysm development [3].

Goals and objectives:

To conduct a literature and scientific research on topic "Impact of exercise on patients with epilepsy". To determine an effect of exercise on the body of patients with epilepsy. To study the morphofunctional changes in epilepsy. To determine the relationship of physical activity in patients with various forms of epilepsy in the different age groups at the medically induced remission stage.

Materials and Methods: On the basis of SVS Laboratory of epilepsy, convulsive states and family monitoring named after V.M. Savinov there were examined 61 patients diagnosed with epilepsy in remission. After everyone’s prior consent to the study was obtained, two groups were created: patients without clinical and neurophysiological disorders and patients without clinical implications but with epileptiform activity on EEG.

Examination Protocol:

The patient takes daily video EEG monitoring. The examination is conducted in a separate specially equipped room. Electrodes are scalp ones, and are applied according to the Jasper 10-20 international system. The examination is conducted by means of the Neuron-Spectrum 4 unit. Recording is held under the international protocol and the protocol of the Association of Neurophysiologists of Kazakhstan.

If the patient undergoing control daily EEG monitoring has no decline in health as compared with previous EEGs, and there are no clinical deteriorations, then such patient is included into the group under study. Examination and consultation by a therapist to exclude somatic deviations. ECG at rest according to a 12-channel monitoring protocol. After that, examination with physical activity takes place, which is carried out on veloergometer ER900 \ LE \ LSE in a special room, remote from potential sources of electrical noise with a comfortable air temperature (20 C). The room shall be equipped with a defibrillator and set of tools for emergency treatment. CG electrodes are applied to the patient by a 12-channel monitoring protocol. A step load with an interval of 3 min is activated. A pedaling speed is 60 rpm.

Step I - 20 W/ Step II - 40 W/ Step III - 60 W/ Step IV - 80 W/ Step V - 100 W/Step VI - 120 W/ Step VII - 140 W

Duration of the load on each step is 3 min.

A method of calculation of a maximum heart rate: (220 – patient’s age in years) *

0.85 = 85% of a maximum permissible heart rate for a man in this age group corresponding to intensive training.

- Measurement of blood pressure is made prior to the beginning of the study, before each increase of load, after the test completion, in 15-20 minutes after completion of the study.

- The clinical criteria for trial termination are as follows: reaching a maximum or submaximal heart rate, the occurrence of dizziness, severe weakness, headache, shortness of breath, patient’s refusal from further study.

- All this time synchronous EEG video recording is being done.

- Upon completion of testing on a bicycle ergometer the patient is to be on video

EEG monitoring and under the control of a therapist for one day more.

Exclusion Criteria for Patients:

- Patients without a stable remission

- Patients with somatic pathology

- The patient’s negative attitude to the study

- Aged under 7 years

- Increase of epileptiform activity in response to functional tests during clinical

EEG recording.

Results: The patients were divided into groups for the purpose of peak load differentiation.

Depending upon the age:

- Group 1 - under 11 years,

— Group 2 - under 16 years,

— Group 3 - under 30 years,

- Group 4 - older than 30 years.

Depending on a form of epilepsy, duration of clinical medically induced remission, subject to EEG neurophysiological readings:

1. Absence on EEG of epileptiform activity at entry before exercise - 55 patients (91.2%)

2. Presence of epileptiform activity at entry before exercise - 6 patients (9.8%)

In the test group there are 7 men (11.4%) and 8 women (13.1%) with idiopathic forms of epilepsy (Tables 1,2), 27 men (44.3%) and 19 women (31.1%) with symptomatic forms of epilepsy (Tables 3,4). Among them, 8 men (13.1%) and 4 women (6.5%) with remission up to 1 year (Tables 5,6), 8 men (13.1%) and 5 women (8.2%) with remission of 1 to 3 years (Tables 7,8) and 18 men (29.5%) and 16 women (26.2%) in remission for more than 3 years (Tables 9,10).

During the exercise test in patients who do not have a specific pathological activity on EEG, no occurrence of epileptiform activity was observed. In those patients under study who had disorders on EEG before the trial, no increase in its severity index was observed in any of the age groups.

Table 1 - (men with idiopathic forms of epilepsy)

Table 2 - (women with idiopathic forms of epilepsy)

Tables 3 and 4 - show patients with symptomatic focal form of epilepsy.

Table 3 - (men with symptomatic forms of epilepsy).

Table 4 - (women with symptomatic forms of epilepsy).

Tables 5 and 6 include the data about patients who were distributed by the period of medically induced remission: up to a year, from one year to three years, and more than three years.

Table 5 - (men with medically induced remission up to 1 year)

Table 6 - (women with medically induced remission up to 1 year)

Tables 7, 8 show remission from 1 to 3 years.

Table 7 - (men with medically induced remission from 1 to 3 years).

Table 8 - (women with medically induced remission from 1 to 3 years).

Tables 9 and 10 show remission in men and women from 3 and more years.

Table 9 - (men with medically induced remission for more than 3 years).

Table 10 - (women with medically induced remission for more than 3 years).

Keeping watch over for patients pursuing an active lifestyle, we identified their

better social adaptation and less susceptibility to stress and depression.

CONCLUSIONS

1. After a study of 61 patients with various forms of epilepsy in different age groups against the background of medically induced remission had been conducted, not a single case provoked deterioration of the brain activity according to the EEG data in response to artificially created moderate physical exercise.

2. There exists an opinion that physical exertion can adversely affect the condition of patients with epilepsy and influence the frequency of attacks, reduces the body's resistance to hypoxia and impairs somatic background, and deprives people of bright colors of life.

3. Based on the international experience, moderate exercise has not only a favorable effect on health, but also helps fight depression, irritability and low mood.

4. Undoubtedly, researches in this area still need to be conducted to determine clear criteria for making recommendations for the inclusion of physical activity in the system of fighting against epilepsy and social rehabilitation of patients.

REFERENCES

1. Гнездицкий В.В. Обратная задача ЭЭГ и клиническая электроэнцефалография. – 2004.

2. Национальное руководство «Неврология»/ Гусев Е.И., Коновалов А.Н., Скворцова В.И., Гехт А.Б. – 2009.

3. Биохимия /Замай Т.Н., Титова Н.М., Елсукова Е.И., Еремеев А.В.. – Красноярск : ИПК СФУ, 2008. - C. 124-125.

4. Зенков Л.Р. Клиническая электроэнцефалография с элементами эпилептологии: Руководство для врачей. - 2004.

5. Карлов В.А. Эпилепсия у детей и взрослых женщин и мужчин: Руководство для врачей. - М.: ОАО Издательство «Медицина», 2010. – С. 11

6. Макаров Г.А. Спортивна Медицина: Учебник. - 2003.

7. Мухин К.Ю., Петрухин А.С., Глуховой Л.Ю. Эпилепсия, атлас электроклинической диагностики — М.: «Альварес Паблишинг», 2004. – C. 9-10, 42, 45.

8. Одинак М.М. Частная неврология. - Спб.: Издательство «Лань», 2002. – С. — 235-236.

9. Петрухин А.С. Руководство «Клиническая детская неврология» - М.: Издательство «Медицина», 2008. – C. 37, 42, 870, 872.

10. Ткаченко Б.И. Нормальная физиология человека/ 2-е изд. - М.: Медицина, 2005. – C. 763-790.

11. Триумфов А.В. Практическое руководство «Топическая диагностика заболеваний нервной системы». – 2007.

12. Штульман Д.Р., Левин О.С. Неврология. Справочник практикующего Врача/ 2-е издание, переработка и доплонение. — М.: «Дпресс-информ», 2002. – C. 554-555, 560-561, 567.

Т?ЙІН

Ситников И.Ю. 2, Есимова Г.Н. 2, Михайлова Н.В. 2, Джайнакбаев Н.Т. 1, Савинов С.В 2, Абедимова Р.А. 1, Акчурина Я.Е. 1, Бондарева И.В. 2, Утебеков

Ж.Е.2, Синицина Т.Н. 2

1 ?аза?-Ресей Медицина Университеті (Алматы),

2 В.М. Савинов атында?ы эпилепсия ж?не тырыспалы мемлекеттердін лабораториясы (Алматы)

ЭПИЛЕПСИЯМЕН АУРАТЫН НАУ?АСТАР?А ДЕНЕ БЕЛСЕНДІЛІГІНІ? ?СЕР ЕТУЫ

В.М. Савинова атында?ы эпилепсияны, тырысу салдарын ж?не жан?ялы? мониторингті окып білу SVS зертханасы базасында, ?рт?рлі жаста?ы, ?рт?рлі эпилепсия т?рлерімен ауыратын топтарга велоэргометрия к?мегімен азда?ан физикалы? к?ш т?сіру ар?ылы зерттеулер ж?ргізілді.

Біз ?олда бар ?дебиеттерден эпилепсияны? патогенезі, а?заны? ?ызметтері ж?не ж?йке жасушаларыны? патогенезіне м?ліметтеріне с?йене отырып талдаулар ж?ргіздік. Велоэргометрия ж?не синхронды бірге ж?ргізілген ?за? мерзімді видео

ЭЭГ к?мектерімен ремиссияда?ы нау?астар?а физикалы? к?штемелерді? ?серін ба?алады?. Б?л ж?мыс эпилепсиясы бар нау?астарды? ?леуметтік ж?не медициналы? бейімделуі ?рдісіне зор ?лесін ?осатыны аны?.

РЕЗЮМЕ

Ситников И.Ю. 2, Есимова Г.Н. 2, Михайлова Н.В. 2, Джайнакбаев Н.Т. 1, Савинов С.В. 2, Абедимова Р.А. 1, Акчурина Я.Е. 1, Бондарева И.В. 2, Утебеков

Ж.Е.2, Синицина Т.Н. 2

1 Казахстанско-Российский Медицинский Университет, Алматы

2 SVS Лаборатория изучения эпилепсии, судорожных состояний и семейного мониторинга им. Савинова В.М., Алматы

ВЛИЯНИЕ ФИЗИЧЕСКОЙ НАГРУЗКИ НА БОЛЬНЫХ С ЭПИЛЕПСИЕЙ

На базе SVS Лаборатории изучения эпилепсий, судорожных состояний и семейного мониторинга им. В.М.Савинова (Алматы), были проведены исследования группы пациентов с различными формами эпилепсии, разных возрастов, в условиях умеренного физического напряжения с помощью велоэргометра.

Мы провели анализ имеющихся литературных данных по патогенезу эпилепсии, деятельности организма и нервной клетки. С помощью велоэргометрии и синхронного длительного видео ээг мониторинга оценили влияние физических нагрузок на пациентов, находящихся в ремиссии. Данная работа, несомненно, должна внести свой вклад в процесс социальной и медицинской адаптации пациентов с эпилепсией.