Abstracts

Rationale: Knowledge of the risk of submersion and drowning in children with epilepsy would be useful in order provide anticipatory guidance to the families/care providers of these individuals. Therefore, we sought to answer the following questions based upon an evidence-based review of the literature: 1) What is the risk of submersion or drowning in children with epilepsy? 2) Does the risk vary with the age of the child? 3) Does the risk vary with seizure type? 4) Does the risk vary with seizure frequency? 5) Does the risk vary with specific Anti-Epileptic Drugs (AEDs)? 6) Does the risk vary with AED levels? 7) Does the risk vary with developmental status? 8) Does the risk vary with different immersion locations (e.g. bathtub, swimming pool, open water)?Methods: MEDLINE and bibliography search including English language articles, 1966-2005, that reported two or more cases of submersion/drowning in people with epilepsy that included children.Results: Twenty-nine articles met inclusion criteria of which 5 were evidence level V and 24 were evidence level IV. Epilepsy confers a 4-7.5% risk of drowning/submersion to a child with the condition. Children with epilepsy who drown/submerge are more likely to be over five years old than those without epilepsy. Children with epilepsy are at the greatest risk of drowning in the bath. Swimming pools present the second greatest risk of drowning to the child with epilepsy. In both locations, the risk is greatest if the child is over five years old. Some data suggest, but do not establish that therapeutic AED levels are helpful, although not always protective. Generalized tonic-clonic and complex partial seizures seem to pose the greatest risk.Conclusions: No data exists meeting our criteria stronger than Evidence Level IV. Suggestions are made for appropriate next steps for research addressing these questions. Caution is warranted for the child with epilepsy in the bath, and swimming pool, especially if over five years old. The data suggests close supervision is protective, especially in the bath. Therapeutic AED levels should be maintained. Further research is warranted.