Abstracts

RATIONALE: The first-ever generalised tonic-clonic seizure (GTCS) carries serious vocational, social and prognostic implications. However, there is no data on the morbidity of these seizures and in particular, the risk of injury has never been documented.
METHODS: Prospective analysis of adult patients attending a first-seizure clinic. Seizure-related injuries were defined as any injury other than oro-lingual trauma occurring as a direct result of the seizure. These were identified during the initial emergency room assessment and were further analysed using a standardised questionnaire during attendance at the first-seizure clinic. In order to identify risk factors for seizure-related injury patients with injuries were compared to those without.
RESULTS: Of 240 patients referred to the first-seizure clinic over a one-year period 141 had tonic-clonic seizures. 34 patients identified with previous GTCS were excluded. Of the remaining 107 patients injuries occurred in 31 (29%). Head injury, usually minor involving a contusion or laceration, occurred in 19 patients (61%). No skull fractures or significant brain injuries were seen. Fracture/dislocation (five shoulder dislocations, one scapula fracture) occurred in six patients (19%). Multiple injuries predominantly involving limb contusion or laceration occurred in six patients. There were no deaths or major physical sequelae as a result of these injuries. The age distribution and gender of the patients with seizure-related injuries did not differ from first-seizure patients without injuries. Seizures arising from sleep were rarely associated with injury (1/31 versus 22/76, p=0.003). Acute provoked seizures occurred in 10 patients with seizure-related injuries (32%) as opposed to 11 patients without injuries (14%, p=0.05). Remote symptomatic etiologies were seen in similar proportion of patients with and without seizure-related injuries. There was no difference in the rate of injury in patients who had a secondarily GTCS as compared with a primarily GTCS.
CONCLUSIONS: The first-ever seizure is frequently associated with injury, most commonly minor head contusion or laceration. Serious injury including shoulder dislocation occurs in a significant proportion. In this series provoked seizures were associated with a higher risk of seizure-related injury. Long-term follow up of first-seizure patients may yield further data on the patterns of seizure-related injury in patients who develop epilepsy.
Support: Nil