Injuries from seizures are a serious, persistent problem in childhood onset epilepsy: a population-based study.

PURPOSE: Document the frequency, types and risk factors for injuries caused by seizures for people with childhood onset epilepsy.

METHOD: We contacted patients with all types of epilepsy except childhood absence from the Nova Scotia Childhood Epilepsy population-based cohort. Seizure onset was between 1977 and 1985. Patients and parents were asked about serious injuries resulting from a seizure, defined as severe enough for an urgent physician or dentist visit.

RESULTS

Of 595 eligible patients, we contacted 472 (79%). During an average follow up of 23.9 ± 8 years, 52 (11%) experienced ≥1 serious injury for a total of 81 injuries. Of all injuries, 24 (30%) were lacerations requiring sutures, 15 (19%) fractures, 11 (14%) broken teeth, 8 (10%) concussions, 4 (5%) burns, and 20 (25%) other. "Other" included 1 fatal drowning, 2 near-drownings, 3 shoulder dislocations and 1 severe eye injury. Four injuries occurred with the first seizure; all others after a long gap from seizure onset (range 1.5-30 years). Injuries occurred in all epilepsy syndromes, most commonly with symptomatic generalized epilepsy (17% vs. 11% p = 0.03) and intractable epilepsy (28% vs. 8% p<0.0001). Most injuries occurred during normal daily activities and were judged not to be easily preventable.

CONCLUSIONS

During ∼24 years of follow up 1 out of 10 patients with childhood onset epilepsy had a serious injury as the result of a seizure. Most injuries occurred years after the initial diagnosis and were more common when seizures were more frequent. The only practical solution to injury prevention is better seizure control.