People with epilepsy sometimes feel that the benefits of swimming do not outweigh the risk of having a seizure in the water. Others may want to swim, but are prevented by anxious family members, teachers or swimming pool staff. However, by taking a few simple precautions, most people with epilepsy can safely participate in swimming and other water sports. Apart from being a highly enjoyable activity and excellent exercise, knowing how to swim is a vital safety measure.
Parents and teachers who do not wish children with epilepsy to swim should consider that being a non-swimmer is far more risky than learning to swim in a safe environment. Especially in South Africa, swimming is often an important social activity, and children may feel left out and "different" if they are kept from joining in. Learning to swim improves self-confidence and social skills.
Under controlled conditions, the risks from swimming for people with epilepsy are in fact minimal, and there have been few recorded cases of drowning. Research shows that few seizures actually occur in the water. Nevertheless, it is impossible to be certain that a seizure will not occur, and it is always essential to follow a few simple safety measures.
A seizure in the water: what to do
- Speak to your doctor about whether your or your child's seizures are sufficiently well controlled to permit swimming.
- Don't swim alone. Preferably, only swim when there is a qualified life-saver present. If not, at least make sure you are accompanied by a strong swimmer who would be able to assist you, and don't go deeper than your companion's shoulder height. People with poorly controlled epilepsy should only swim where there is continuous one-on-one supervision.
- Tell the pool supervisor or your swimming companion that you have epilepsy, and check that they know what to do if you have a seizure.
- Only swim where you feel safe and confident. Avoid overcrowded pools. Swimming in the sea, rivers, lakes or very cold water is dangerous and generally not recommended.
- Don't swim if you're feeling unwell or tired, or have recently changed your medication or have missed any doses.
- Don't get too tired or cold while in the water.
- Consider using an inflatable ring or other device that supports your child's head above the surface of the water.
- If you have photosensitivity (your seizures are triggered by flashing light) wear polarised sunglasses to reduce the flicker effect of sunlight reflecting off water.
The classic sign of onset of a generalised tonic-clonic seizure in the water is a loss of co-ordination in the swimming stroke. The swimmer's sense of direction appears vague and involuntary head movements may occur. If someone has a convulsive seizure, or any kind of seizure in the water where their level of consciousness is altered, take the following steps:
- Stay in the water with the swimmer. You might need extra assistance so call out for help.
- Hold the person's face above water. It is best to approach from behind, and support the head above the surface.
- Don't put anything in the person's mouth and try not to restrict their movements.
- Guide them away from the sides of the pool to avoid injury during the seizure.
- Move the person to shallow water when this becomes possible, keeping the head above water all the while.
- Once abnormal movement has stopped, move the person onto dry land and lay them on their side to recover.
- A suitably trained person should commence resuscitation if this is required.
- Call for emergency medical services if:
- breathing is laboured or a lot of water has been ingested
- the seizure continues for more than five minutes, or a second seizure starts shortly after the first has ended without the person regaining consciousness in between
- injury has occurred.
- Stay with the person until they are feeling well again. Even if breathing seems to have returned to normal and the person appears to have recovered, water may have been inhaled. Anyone who has had a seizure while in the water should have a medical check-up immediately afterwards.
Seizure types such as complex partial seizures (the person typically appears confused or distracted, and may make repetitive movements), or absence seizures (the person loses consciousness and "goes blank" for a few seconds) do not usually require emergency action, but care must be taken that the person does not sink. Once the seizure has passed, the person may not realise what has happened or feel tired or confused, so be reassuring and offer to help him or her out of the water and rest until they feel sufficiently recovered.
Emergency first-aid treatment for a convulsive seizure