THE IMPACT OF A STRUCTURED 12-WEEK COMBINED AEROBIC AND RESISTANT MODERATE INTENSITY EXERCISE ON INDIVIDUALS WITH TEMPORAL LOBE EPILEPSY: A RANDOMIZED CONTROLLED TRIAL (RCT)

A Research Proposal On The Role of Structured Exercise Programs in Managing Temporal Lobe Epilepsy: A Systematic Review Your Name Subject and Section Professor’s Name Date Introduction Temporal lobe epilepsy (TLE) is the most frequent type of MRI-negative focal epilepsy in adults, in which hippocampal sclerosis (HS) represents the principal tissue changes. It is defined by focal seizures arising from the temporal region, and its pharmaco-resistance presents conceptual difficulties in treating epilepsy (Bernhardt et al., 2019). Magnetic resonance imaging (MRI) has proved significant in establishing histopathologic differences concerning patients with TLE, and measures of atrophy and T2 signals serve as progressively refined indices of cell death and glial scar. These imaging studies have shown that there are whole-brain structural deficits, which involve the alteration of grey matter areas and white matter bundles (Verma et al., 2021). Today, TLE is regarded as a disorder that affects various brain areas Nevertheless, the hippocampal-based network conceptualization has remained unnoticed in the literature, and there needs to be more systematic exploration. Structural connection analysis of the pilot group of patients has addressed only preoperative clinical characteristics, disregarding the severity of hippocampal lesions (Chauhan et al., 2022). Furthermore, there is still a paucity of investigations investigating the direct association between hippocampal in vivo markers and connectome properties of white matter (Bernhardt et al., 2019). Therefore, these significant gaps in the literature provide the rationale for systematic studies that map out these interconnections. Patients with drug-resistant TLE are often candidates for surgical treatment, with anterior temporal lobectomy (ATL) and more selective mesial temporal or neocortical resections affording considerable seizure amelioration or even seizure-free status in many cases. However, certain patients make poor surgical candidates because they either can experience significant damage to their memory or language or because they have bitemporal illness (Bauman et al., 2019). Furthermore, the perceived “brain surgery” and patient view also contribute to the detrimental underutilization of epilepsy surgery. Techniques like stereotactic laser ablation and neurostimulation are relatively new, less invasive procedures than craniotomy (Sperling et al., 2020). There is some effectiveness. However, these can differ in outcomes according to the location of the ablation and the level of the procedure: radiofrequency ablation or RF and laser interstitial thermal therapy (LITT). Techniques such as inhibitory neuron transplant and genetic treatment are in clinical trials in humans, suggesting that an attempt is already being made to develop more tolerable and patient-centered treatments (Sperling et al., 2023). As a result, there is an increasing desire for alternative treatments that may supplement pharmacologic therapies and enhance patient prognosis. The research by Arida (2021) focuses on the benefits of physical exercise in epilepsy, which has become a viable complementary therapy in treating epilepsy. Several aspects of exercise have been shown to contribute to improved brain function, such as the promotion of neurogenesis, increase in synaptic plasticity, and increased cerebral blood flow. According to Ferrer-Uris et al. (2022) aerobic exercise and strength conditioning, especially cardiovascular, have demonstrated the possibility of improving cognitive status and decreasing seizure frequency in both children and adults. These exercises have been linked to altering neurotransmitter systems, decreasing oxidation pressure, and increasing neuroplasticity, which are all relevant to epilepsy. However, these findings only explore generalized indications of physical exercise. Still, little is known about the impacts of structured exercise programs, such as particular aerobic and moderate-intensity resistance exercises, on those diagnosed with TLE. Studies are limited to the existing literature on epilepsy populations or other neurological ailments, creating a considerable knowledge gap concerning exercise in patients with TLE. There is a need to fill this gap as TLE is a severe condition that affects many brain networks, and specific non-pharmacological interventions could have significant benefits. The general objective of this systematic review is to critically determine the effects of a structured aerobic and moderate-intensity resistance exercise training program in patients with TLE. Primarily, the aim is to evaluate whether this type of intervention will likely generate changes in seizure rate, cognitive functioning, and quality of life. Secondarily, the objective is to identify how exercise influences the epileptic state directly and indirectly by examining the roles of neuroplasticity and neuroprotection. The rationale for this review arises from rich literature evidencing the various factors through which exercise improves the brain. Prior research has suggested that exercise influences neurotransmitters, oxidative stress, and neurogenesis, all of which are implicated in epilepsy (Johnson et al., 2020; Nowacka-Chmielewska et al., 2022). Thus, a structure of knowledge based on the discussed approach to exercise as a therapeutic instrument for TLE treatment is presented in the present review to help contribute to the non-medicinal resources to improve patients' quality of life with the severe condition. Literature Review This literature review focuses on the effects of aerobic and moderate-intensity resistance exercises on patients with TLE. Current research suggests that this exercise routine may promote better patient seizure outcomes and general vitality (Arida, 2021). Arida (2021) offers a comprehensive literature review examining the advantages and disadvantages of using physical exercise as an adjunct therapy for epilepsy. It also talks about how physical exercise can significantly reduce the likelihood of having a seizure and improve the living standard of epilepsy patients by affecting neurotransmitters and neurotrophins and influencing the metabolic state of the brain. This article reveals that there are new scientific findings that show that exercise can tailor epilepsy-linked complications like depression and anxiety and that exercise can improve elemental cognitive factors that are requisite for increasing the quality of life of patients suffering from this condition. Also, the review highlighted numerous exercise-related precipitating factors that are likely to cause seizures in clients with epilepsy, such as fever, low blood sugar, low sodium levels, low oxygen levels, rapid breathing, exhaustion, and anxiety. Although most of these factors do not cause seizures when a patient is engaged in other regular activities, including moderate exercise, they highlight some conditions that should be closely monitored in such patients. Equally, Johnson et al. (2020) systematic review reveals that individuals with epilepsy are less physically active than those who do not have epilepsy, and PA intervention has an enhancement in PA and health-related qualities of life but is not injurious to seizure frequency. To achieve this, the authors conducted a systematic review to analyze PA in PWE compared to non-epilepsy controls to determine the factors related to the PA of patients with epilepsy. These 46 studies include case-control, cross-sectional, and intervention investigations identified by PRISMA guidelines (Page et al., 2021). The approaches used for this factor include self-administered questionnaires, activity monitors, and physiological fitness indices. The outcomes demonstrate that PWE has lower levels of PA than non-epileptic counterparts. Notably, more than half of the case-control studies with self-report questionnaires and two-thirds of the case-control studies with exercise/fitness tests indicated that PWE were less active and worse in terms of physical fitness. PA interventions demonstrated enhanced PA and HRQoL of PWE without worsening their seizures. Like Johnson et al. ’s (2020) study, van den Bongard et al. ’s (2020) systematic review deals with the effects of exercise and physical activity on patients with epilepsy, with an emphasis on whether patients with epilepsy exercise less than the general population and the influence of exercise application on comorbidities and seizure manifestation. This systematic review included 42 papers that included case-control, cross-sectional, and intervention studies concerning the impact of social media usage, and their methodological quality was evaluated, with the evidence level in each being assigned. The methods allowed for a search of the scientific literature in the PubMed and Web of Science databases by specific terms for epilepsy and physical activity. In the random review of research, papers under study were of different methodological designs in terms of surveys and interviews, measurements of physical fitness, training, and education. The findings have shown that patients with epilepsy exercise significantly less and have lesser levels of fitness as compared to the average population. Also, physical activity was correlated with a favourable change in the HRQoL and the rate of comorbidity, including anxiety and depression. Notably, most of them state that participation in physical activities does not result in worsening seizures, and some reveal a decrease in seizures. Lastly, the case report by van der Kop et al. (2019) on the subject involves the changes of a drug-resistant focal epilepsy patient who was previously doing a moderate exercise program to undergo a CrossFit training post-craniotomy for low-grade glioma. In this case, the method employed was obtaining the patient's exercise history, the frequency of seizures, and the other health indicators when the CrossFit program was introduced. Their exercise regime was moderate before admission, including playing tennis, hiking, yoga, and exercising at home using fitness videos. The patient then changed her training routine to attend CrossFit training involving aerobics, Olympic weights, callisthenics, and gymnastics thrice a week for six months. This study showed a positive outcome, demonstrating a decrease in seizures, with the research showing 33% less in six months. The patient also benefited in terms of the psychological domain through reduced suicide ideation and improvement in quality of life. Most of the seizures happened in the morning hours, but it has been acknowledged that no seizures were experienced during CrossFit classes or soon after exercising. Research Gap Although Arida (2021) offers a comprehensive review of the potential advantages of exercising in the context of epilepsy, the author did not assess the effects of a schedule of moderate intensity combined aerobic and resistance training on individuals with TLE or any form of epilepsy, pointing to an existing literature gap and emphasizing the importance of future studies that aim to identify the precise effects of such combined interventions for this specific population. Likewise, Johnson et al. (2020) stress that comorbidities related to sedentary lifestyles are detrimental to the quality of life of persons with epilepsy, though, referring to aerobic and resistance training, they comment on the scarcity of methodologically sound research into the effects of aerobic and resistance training on seizure frequency and overall quality of life in TLE patients. , such as Van den Bongard et al. (2020) have also stated this as a vast research gap pointing to the need to conduct more studies on how drug combinations and exercise regimes affect the seizure control and quality of life in PWE. Moreover, van der Kop et al. (2019) also note that future and extensive research is needed to provide more formal and specific evidence regarding the effects of the structured combined aerobic and resistance moderate-intensity exercise program on seizure activity and well-being while also stressing the overall unexplored area of using such techniques. These studies collectively highlight a significant need to examine the evaluation of structured combined exercise regimens to determine their applicability to patients with TLE. Research Methodology Research Design This systematic review will assess the effects of both structured aerobic and moderate aerobic and resistance training on TLE patients. Evaluations will be conducted by the PRISMA 2020 guidelines to provide a detailed and transparent systematic review (Page et al., 2021). Databases and Search Strategy The systematic review will seek to use various databases to ascertain literary research that reflects on the effect of Structured exercis...