Can green spaces reduce the risk of sudden death in people with epilepsy?
The idea that environment influences the health of people with epilepsy is not a new one. Epilepsy Society headquarters was founded in 1894 in the Buckinghamshire countryside precisely for that reason. The founders of the charity and 'colony' as it was then known, believed that outdoor activity was the key to maximising the health and potential of the people with epilepsy that came to live at the centre in Chalfont St Peter.
Now, scientists from the Universidade Federal de São Paulo in Brazil have called for research to be done into the connection between access to green spaces and a reduction in the risk of sudden unexpected death in epilepsy (SUDEP) among people with epilepsy.
Stress linked to mortality and epilepsy
Writing in a letter to the editor of the Elsevier journal, the scientists identified stress as a factor in the debate around mortality and epilepsy. Aside from the stress of receiving an epilepsy diagnosis, the authors highlighted lifestyle factors such as employment difficulties and drug side effects as causes of chronic stress which can increase susceptibility to seizures.
They continued by explaining that, despite cities having better socioeconomic conditions, access to sanitation, nutrition and healthcare services than rural areas, there is a greater exposure to stress and vulnerability which may be "the most important factors" in the increased risk of epilepsy in urban areas.
Modern city life
They argue that, as modern city life is becoming an inevitable fact of life for many people, it is necessary to improve our understanding of the negative influences of urban living. They also call for the development of new methods other than medical therapies, of preventing the onset of general health problems in people living in high-stress urban environments.
Epilepsy Society comment
Professor Ley Sander, medical director at Epilepsy Society commented: 'Epilepsy drugs have been the mainstay of treatment for people with epilepsy for over a hundred years, but we know there are many other factors which can contribute to good seizure control and quality of life.
'Treating people holistically is fundamental to managing their epilepsy. This includes looking at lifestyle, diet, social networks and other accompanying conditions. We all know how rejuvenating a walk in the park or through woods can be. It gives the mind and the body time to process, relax, switch off from daily stresses and recharge.
Seizure control when stress is a trigger
'If our mental and general physical health is better, it has to help with seizure control, particularly for those whose seizures are triggered by stress. Urban living is a way of life for the majority of people in this country and for our general health it is important to find space and tranquillity where we can unwind and give ourselves a breathing space.
'Good seizure control, along with medication adherence, is critical in managing the risks around SUDEP. More research into the potential benefits of green space in achieving this could be enlightening.'
The benefits of green space
The letter's authors cite several studies that have demonstrated that exposure to the natural environment, or 'green space', has an independent effect on health and health-related behaviours. These green spaces are classed as "open, undeveloped land with natural vegetation", including parks, forests, playing fields and rivers. An overview of the studies found that individuals living in the greenest environments have better physical and mental health, due to the reduction of blood pressure, obesity and number of symptoms they experience.
Call for further studies
The authors suggest that, as stress can be seen as a contributing factor to increased seizure activity that leads to a greater risk of SUDEP among people with epilepsy, access to green environments may help to reduce the stress levels that cause seizures.
The letter concludes by calling for studies to establish with precision the significance of green spaces and its possible protective effect against increased mortality occurrence in people with epilepsy. It also suggests that exploring the benefits of green spaces could "open new perspectives" for the treatment of people with epilepsy.
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