Letter to the Editor

Physical exercise as a coping strategy for people with epilepsy and depression

Mental health and physical health are intrinsically linked, yet the mechanisms are not well understood. We investigated whether moderate-vigorous physical activity (MVPA) mediated the association between depression and physical function (PF) in midlife.

Individuals from two UK birth cohorts born within one week in 1958 (n = 7278) and 1970 (n = 6097) with data on depression (ages 33/34; Malaise Inventory), MVPA (age 42; self-reported) and PF (ages 50/56; Short Form-36 subscale). Covariates included sex, childhood and adulthood social class, maternal mental health, childhood mood, alcohol consumption, smoking habits, sleep, marital status, BMI and long-standing illness/disability. Linear or multinomial logistic regression models examined associations between depression, MVPA and PF. We used a parametric g-computation mediation analysis approach to estimate percent differences in PF.

Depression was associated with less frequent MVPA and poorer PF. Lower MVPA was associated with worse PF. The direct effect – randomised analogue not operating via MVPA – of depression on PF was −18.8 % (95%CI:--25.8,-11.8) and −15.8 % (20.6,-11.0) in the 1958 and 1970 cohorts, respectively. The indirect effect – operating via MVPA – was −0.5 % (−1.0,-0.03) and −0.2 % (−0.6, 0.3), resulting in a total proportion mediated of 3.1 % (0.1, 6.0) and 0.9 % (−1.6, 3.4).

MVPA was self-reported. Intermediate confounders and mediators were measured at the same age, however associations did not change in sensitivity analysis considering age 46 MVPA (1958 cohort).

Although higher MVPA was protective against poor PF, there was only minor evidence that it mediated the association between depression and PF. Further investigation into other potential mediators of pathways from mental to physical health is needed.

To investigate psychopathological reaction to traumatic stress, addressing in particular gender difference, in parental couples of children affected by epilepsy.

50 mothers and 50 fathers, paired for one’s child, of children followed at the Pediatric Unit of a major Italian University Hospital with a diagnosis of epilepsy were enrolled, screened by means of the Semi-structured Clinical Interview for DSM-5 (SCID-5) and filled the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress symptomatology.

25 % of the total sample presented a diagnosis of PTSD with a statistically higher prevalence of mothers (36 % and 14 %, respectively; p = .021). Furthermore, 44 % (48 % mothers and 40 % fathers) presented a partial PTSD. Important gender differences emerged also for all cluster dimensions of the TALS-SR except for the Avoidance. Finally, the analysis of the single items of the TALS-SR evidenced that in mothers subgroup prevail cognitive symptoms of fear and sadness as well as somatic manifestations.

Our results point out the differences between mothers and fathers in trauma response and underline the need to develop gender targeted models of healthcare prevention and assistance.

Epilepsy is the most common neurological chronic condition worldwide, affecting about 2% of world population. Temporal lobe epilepsy (TLE) reaches 40% of all cases of this condition, and it is highly refractory to pharmacological treatment. Physical activity has been suggested as complementary therapy for epilepsy. However, there is no consistent information whether all these effects are plenty applicable to females, since clinical and experimental studies concerning physical exercise and epilepsy are largely performed in males. Females are worthy of special attention due to gender specific particularities such as hormonal cyclical rhythm and possible pregnancy. Therefore, this study aimed to investigate the impact of two types of exercise programs (Forced and Voluntary) in female Wistar rats submitted to temporal lobe epilepsy induced by pilocarpine.

Animals were divided into four groups: Control (healthy), Epilepsy, Epilepsy/Forced (exercise in a treadmill) and Epilepsy/Voluntary (free access to wheel). Behavioral and histological analyses were evaluated among groups.

Voluntary exercise was able to reduce seizure frequency and anovulatory estrous cycle occurrence. Yet, both types of exercise attenuated the mossy fiber sprouting in dentate gyrus.

Our results indicate that voluntary exercise exerts a positive effect on epilepsy in female gender. Further investigations are necessary to better elucidate mechanisms involved in these responses, since these effects do not act in the same manner in male and female rats.

In epilepsy, the most common serious neurological disorder worldwide, several investigations in both humans and animals have shown the effectiveness of physical exercise programs as a complementary therapy. Among the benefits demonstrated, regular exercise can decrease the number of seizures as well as improve cardiovascular and psychological health in people with epilepsy. While many studies in animals have been performed to show the beneficial effects of exercise, they exclusively used male animals. However, females are also worthy of investigation because of their cyclical hormonal fluctuations and possible pregnancy. Considering the few animal studies concerning seizure susceptibility and exercise programs in females, this study aimed to verify whether exercise programs can interfere with seizure susceptibility induced by pilocarpine in adult female Wistar rats. Animals were randomly divided into three groups: control, forced, and voluntary (animals kept in a cage with a wheel). After the final exercise session, animals received a pilocarpine hydrochloride (350 mg/kg i.p.; Sigma) injection to induce seizures. To measure the intensity of pilocarpine-induced motor signs, we used a scale similar to that developed by Racine (1972) in the kindling model. During a 4-h period of observation, we recorded latency for first motor signs, latency for reaching SE, number of animals that developed SE, and intensity of pilocarpine-induced motor signs. No difference was observed among groups in latency for first motor signs and in the number of animals that developed SE. Although the voluntary group presented more intense motor signs, an increased latency for developing SE was observed compared with that in forced and control groups. Our behavioral results are not enough to explain physiological and molecular pathways, but there are mechanisms described in literature which may allow us to propose possible explanations. Voluntary exercise increased latency to SE development. Further investigation is necessary to elucidate the pathways involved in these results, while more studies should be performed regarding gender specific differences.