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Injuries due to seizures in persons with epilepsy

A population-based study

From the Section of Electroencephalography (Drs. Lawn, Radhakrishnan, and So), the Division of Epilepsy (Dr. So), and the Department of Health Sciences Research (W.R. Bamlet and Dr. O’Brien), Mayo Clinic, Rochester, MN. Dr. Lawn is currently affiliated with Western Australia Comprehensive Epilepsy Service, Royal Perth Hospital, Perth, Australia, and Dr. Radhakrishnan with the Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

Address correspondence and reprint requests to Dr. Elson L. So, Section of Electroencephalography, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Background: Previous studies of injuries due to epileptic seizures predominantly involved patients with intractable epilepsy. These studies may have overestimated the risk of injuries in persons with epilepsy.

Methods: Patients consisted of 247 Rochester, MN, residents who were diagnosed with epilepsy between 1975 and 1984. Seizure-related injuries were defined as any injury, other than orolingual trauma, resulting from a seizure, sufficient for the patient to seek medical attention or for injury occurrence to be determined during the course of medical care. To identify risk factors for injury, characteristics of patients with seizure-related injury were compared with those without injury.

Results: During a total of 2,714 patient-years of follow-up, 62 seizure-related injuries were identified in 39 patients (16%, one injury in every 44 person-years). Most injuries involved cranial soft tissue contusions or lacerations (79%). The majority of seizure-related injuries (82%) occurred during generalized convulsive seizures. Univariate analyses identified five potential risk factors for seizure-related injury: greater number of antiepileptic drugs used, less independent living situation, higher Rankin score, history of generalized convulsive seizures or drop attacks, and higher seizure frequency score. Seizure frequency, however, was the only significant risk factor identified by multivariate analysis (p < 0.001; relative risk, 1.33).

Conclusions: This population-based study shows that seizure-related injuries are infrequent and generally of minor severity. In most epilepsy patients, excessive restriction of daily activities to avoid injury is unnecessary. Effective seizure control reliably reduces the risk of seizure-related injuries.

Received December 16, 2003. Accepted in final form June 19, 2004.

See commentary, page 1549

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November 9 Highlight and Commentary
Neurology 2004 63: 1549. [Full Text] [PDF]

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