Elson So, M.D., Mayo Clinic neurologist and lead study investigator, explains that an accurate understanding of injury risk for patients who have epilepsy not only affects the patient, but also family members, schools, employers and the general public.
"It is important to find a balance between seizure precaution and the freedom to enjoy life," says Dr. So. "Unnecessary restrictions of activity can adversely affect quality of life, often to a more serious extent than what seizure attacks can do. Ignoring the risk of injuries may have disastrous consequences for some people with epilepsy. However, overestimating the risk of injuries may unfairly impact on the rights of those with well-controlled epilepsy."
Dr. So urges those who interact with patients with epilepsy in school or work settings to resist automatically placing restrictions on the patient.
"People with well-controlled epilepsy should not arbitrarily be considered at higher risk of injury than those without epilepsy," he says. "School authorities and work personnel should understand that the risk of injuries from seizures is very small in people whose epilepsy is well controlled. It's comparable to or lower than the risk in many people without epilepsy. It is unfair and illegal to deprive people with well-controlled epilepsy of their opportunities to study or to work."
Dr. So explains that most previous studies of seizure injury rate looked at patients treated for poorly- controlled epilepsy in epilepsy centers or emergency rooms; these studies cited injury risk rates as high as one in three patients. In contrast, Dr. So's study was population based, examining all patients with epilepsy in a given region and time period.
"Our study goes against previously reported studies that may have overestimated the risk of injury from seizures," says Dr. So. "The high injury rate in patients with severe epilepsy investigated in these prior studies does not apply to the general population of people with epilepsy, which would include those with well-controlled as well as those with uncontrolled epilepsy. Our study showed if you take all patients with epilepsy as a group, you'll find out the injury risk is actually very low."
The Mayo Clinic study investigators examined records of 247 patients from Rochester diagnosed with epilepsy between 1975 and 1984. They found 62 injuries due to seizures in 39 of the patients. Eighty percent of the injuries were cuts, scratches or minor bruises to the soft tissue on the outside of the head that did not cause serious health consequences or prolonged absence from work or school.
The two most common types of seizures that cause injuries are generalized convulsive seizures caused by an abnormality affecting most or the entire brain, and atonic seizures, which interfere with a patient's muscle tone. These types of seizures can cause injuries from falls or from loss of consciousness. Complex partial seizures, in which only part of the brain is affected, can lead to injury by interfering with a person's awareness or behavior, without any fall. Injuries from loss of awareness might include drowning, burns and motor vehicle accidents.
The following factors would put a patient with epilepsy at higher risk for injury, according to the study's findings: 1) greater number of antiepileptic drugs used, 2) less independent living situation, 3) higher Rankin score (a measure of disability in which a score of 0 represents no disability and 5 represents total disability), 4) history of convulsive seizures or atonic seizures and 5) high seizure frequency.
The key factor in risk reduction for seizure-related injuries in epilepsy patients is effective seizure control. "Patients with well-controlled seizures have a negligible risk of injury, so patients with epilepsy who have uncontrolled seizures, should work with their doctors toward seizure control and consider all treatment options, including epilepsy surgery," says Dr. So.
In order to minimize any risk for injury from seizures, Dr. So and colleagues recommend the following for all epileptic patients: 1) practice general safety rules when engaged in outdoor activities (e.g., wear a helmet when skating, biking or skiing), 2) take medications regularly as prescribed by your doctor, 3) report medication side effects to your doctor, 4) avoid situations that can worsen seizure recurrence (e.g., lack of sleep, undue stress and fatigue, excessive alcohol consumption, use of recreational drugs), 5) try to stay physically fit and conditioned and 6) have an appropriate companion or supervision for activities that may pose high risk of serious injury if a seizure occurs (e.g., swimming).
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