Abstracts

RATIONALE: Previous studies of injuries in epilepsy patients have been biased towards refractory epilepsy, and therefore may have overestimated the risk of injury. Accurate epidemiologic information is needed to provide patients with rational advice regarding their risk for seizure-related injuries.
METHODS: Subjects consist of 248 Rochester, MN residents whose epilepsy was diagnosed between 1975 and 1984. Patients were followed from time of diagnosis until death, migration out of Rochester, or until December 31, 1997. Seizure-related injuries were defined as any injury occurring directly as a result of a seizure, other than oro-lingual trauma, sufficient for the patient to seek medical attention, or for injury occurrence to be determined during the course of medical care.
RESULTS: During a total follow-up of 2,725 patient-years, 63 seizure-related injuries were identified in 40/248 patients (16 %; one injury every 43 patient-years). Eleven of the 40 patients (28%) suffered recurrent injuries. Although a neurologic deficit was present at the time of injury in 46% of patients, 81% were living independently. Injury occurred at home in 56%, at work in 10%, and in 6% while driving. The majority of injuries were minor extracranial soft tissue contusion or laceration involving the head (50/63, 79%, one per 55 patient-years). Skull fractures without significant brain injury occurred in 2 patients. Fractures/dislocations (thoracic 2, radius 1, clavicle 1, shoulder dislocation 1) accounted for 5 injuries (8%, one per 545 patient-years). No fatal injuries occurred. Only 8% of patients required hospital admission specifically for the seizure-related injury. Although 43% required temporary time off work or school, none of the injuries resulted in prolonged sick leave. Generalized tonic-clonic seizures accounted for 82% of the seizure-related injuries and 16% were related to atonic seizures. In the year prior to injury, 25% of patients had [gt] 1 seizure per week, 40% had [lt] 1 seizure per week, and 35% had excellent seizure control. Alcohol was present in 9% of patients with seizure-related injuries. Of patients whose AED levels were determined at the time of injury, 67% were sub-therapeutic. No injuries were associated with clinical AED toxicity.
CONCLUSIONS: In this population-based study, the occurrence of seizure-related injuries was relatively infrequent. Major injuries were rare, and the social and occupational consequences were generally minor.
Support: Mayo Foundation for Medical Research & Education.