Abstracts

Rationale: Epilepsy is known to carry a high risk of seizure-related injuries (SRI) and has gained much attention in the literature over the past decade. However, most studies are retrospective and data is gathered in an indirect nature, either with questionnaires or relying on documentation in patients’ medical records. Recent literature on SRI shows the usefulness of prospective assessment (Beghi E, et al Epilepsia 2002, 43:1076-83) and the difficulties encountered when depending solely on information obtained from medical charts (Friedman DE, et al Epilepsia 2009, in press). The purpose of this ongoing study is to investigate SRI in people with epilepsy (PWE) in a prospective manner by systematically assessing injuries encountered, their associated risk factors, and circumstances by directly questioning patients during routine clinic follow-up visits. Methods: Inquiries were made regarding SRI in consecutive patients attending a tertiary-care clinic (Baylor Comprehensive Epilepsy Center or BCEC) with a standardized interview previously described (Buck D, et al Epilepsia 1997, 38:439-44) during their initial visit and routine follow-up visits. The interview at follow up specifically questioned for a history of SRI since their last visit. Injuries that patients believed were of a non-seizure-related etiology were excluded. The nature and consequences of the injuries were determined. Results: The systematic assessment has been in practice at BCEC since February of 2008. A total of 76 consecutive adult patients were interviewed at least twice, once during their initial visit, and during follow up visit(s) from February 2008 to April 2009. Mean total follow up visits were 1.54 during this 14-month period. Mean interval between visits was 3.58 months. Forty (52.6%) patients expressed a past history of injury on their initial visit. Nine (22.5%) with a history of SRI experienced at least one SRI on follow-up (recurrent SRI). Recurrent SRI included head trauma (45%), contusion (36%), laceration (9%), and one cervical fracture with dislocation and cord compression. Risks associated with injury were duration of epilepsy (p=0.003), seizure frequency (p=0.02), and symptomatic epilepsy (p=0.04). The strongest predictor for recurrent SRI on follow up was a history of pharmacoresistant temporal lobe epilepsy (TLE), with both complex partial seizures and tonic-clonic seizures (p=0.007). Conclusions: Seizure-related injuries are common when assessed systematically in PWE receiving care in a tertiary clinic. Patients with medication-resistant TLE may be at high risk for recurrent SRI based on the data of this relatively small, highly selected sample. Further prospective assessment is necessary to more definitively determine risks, predictive factors, and potential methods to minimize injuries in PWE.