Abstracts

Rationale: In the general population, injury related to seizures often involves falls, head trauma, soft tissue injuries, burns and fractures. Life threatening injuries have also occurred in Epilepsy Monitoring Units (EMU), in well-equipped rooms, with staff familiar with seizure patients. We seek to identify epilepsy patient's risk for seizure-related injury (SRI) and postictal behavioral changes (PIB). Methods: As part of a quality improvement project, patients admitted to the Detroit Medical Center Wayne State University Epilepsy Monitoring Unit over the course of 5 months (2014) were asked a bedside questionnaire about the types of injuries they suffer due to seizures and about agitation and aggressive behavior occurring after seizures. Patient charts were reviewed for baseline characteristics: age, epilepsy type, seizure frequency per month, history of symptomatic generalized tonic-clonic activity (GTC), and number of anti epileptic drugs (AED). Statistical analysis of variables was done. Results: 32 patients completed the bedside questionnaire. Incomplete questionnaires were excluded. Seizure frequency and the presence of GTC did not impact SRI or PIB. Paroxysmal nonepileptic spells also had an almost similar injury risk as those with epilepsy (62.5 % vs. 50.0%). Patients taking 0 to 1 AEDs were less likely to have PIB as compared to those taking greater than or equal to 2 AEDs (37.5% vs 68.8%; p=0.038 using chi-square analysis). These patients were also less likely to suffer injuries during seizures (without reaching statistical significance). Conclusions: The number of AEDs epilepsy patients take is correlated with an increased SRI and PIB. This may indicate seizure severity or may be due to the side effects of AEDs. The number of seizures, seizure type, and epileptic versus nonepileptic etiologies were not risk factors for seizure related injury and PIB. Larger studies are needed to identify the risk of SRI and PIB in epilepsy patients to develop a predictive model allowing for patient-specific seizure precautions.