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

•Injury due to a seizure occurs in 11% of people with childhood onset epilepsy.•Injury is more common in those with persistent or intractable epilepsy.•Injury type: laceration 30%, fracture 19%, broken teeth 14%, concussion 10%, burn 5%, and other 25%.•The majority of injuries occur many years after the initial diagnosis.•Most injuries occur during normal daily activity and are not easily preventable.

PurposeDocument the frequency, types and risk factors for injuries caused by seizures for people with childhood onset epilepsy.MethodWe 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.ResultsOf 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.ConclusionsDuring ∼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.