Abstracts

RATIONALE: Patients with epilepsy are reported to have an increased incidence of physical injuries. These reports have been based primarily on adult patients receiving antiepileptic medication. One of clinicians[ssquote] concerns for diagnosing epilepsy early and starting antiepileptic medication is to try and prevent physical injuries following an epileptic seizure. The aim of this audit was to investigate the incidence of injuries in newly diagnosed children with epilepsy and prior to starting medication.
METHODS: All newly diagnosed and untreated patients with at least two, unprovoked, afebrile epileptic seizures of any type, aged between 1 and 16 years presenting consecutively to the outpatient department of five paediatric/paediatric neurology departments over 12 months (January-December 2000) were prospectively audited. Information was collected at the first outpatient consultation when the diagnosis of epilepsy was disclosed to the family on the seizure types(s) causing the injuries, the type of injury, how and the age it was sustained and whether hospital treatment was required because of the injury.
RESULTS: One hundred and ninety eight patients (116 males) were audited. Nineteen patients (9.6%) experienced a single (13 patients) or repeated (6) injuries due to one or more epileptic seizure prior to the diagnosis of epilepsy being established. Of the 19 patients with injuries, 13 were male, and 2 (males) had moderate learning difficulties. The injuries occurred at a mean age of 10.3 (range, 4-15.1) years and had occurred at home in 13 patients (including 4 having fallen out of bed during a tonic-clonic seizure and 1 with a myoclonic seizure at her computer), 3 had occurred outside (2 while cycling), 2 at school and 1 in a swimming pool. The seizures causing the injuries were tonic-clonic in 16 (primary in 10, and unknown whether primary or secondary in 6), complex partial in 2 and myoclonic in 1. None of the 36 patients with typical absence seizures in this audit experienced an injury. Injuries included multiple bruising (7 patients), bruising to the face and head (12), cut lips/broken teeth (2) and limb bruising (2). No patient died, sustained a fracture or required hospital attention because of their injury.
CONCLUSIONS: Accidental injury appeared to be uncommon (less than 10%) and mild in this unselected, newly-diagnosed and untreated paediatric population, in contrast to adult patients with chronic epilepsy where the incidence may be as high as 35%. These unique data should help to reassure clinicians that an [ssquote]early[ssquote] diagnosis of epilepsy should not be influenced by the concern that injuries are common in children before starting antiepileptic treatment.
Support: No external source of funding.