Seizure-related injuries in children with newly diagnosed and untreated epilepsy

Purpose: Patients with epilepsy are reported to have an increased risk of physical injury. One of clinicians' concerns for diagnosing epilepsy early is to try to prevent such injuries and also to allay parental anxiety that seizures May cause injuries. The purpose of this study was to investigate injuries in children with newly diagnosed epilepsy and before starting antiepileptic medication. Methods: A prospective study was undertaken of all newly diagnosed and untreated patients with at least two unprovoked, afebrile seizures of any type, aged 1-16 years, presenting consecutively to seven paediatric/paediatric neurology outpatient departments over a 12-month period. Information was collected on the duration of epilepsy before diagnosis, the epilepsy syndrome, the seizure type causing the injury, how and the age at which the injury was sustained. and whether hospital treatment was required for the injury. Results: One hundred ninety-eight patients (116 boys) were surveyed. No patient died as a result of an injury. Twenty-five (12.6%) children experienced an injury before the diagnosis of epilepsy was established. Only four of the 25 patients (2% of all 198 patients) required medical attention for the injury. The injuries occurred at a mean age of 10.3 years (range, 4-15.1 years), and epilepsy was diagnosed at a mean age of 11.1 (range, 4.2-15.8) years. Fifteen patients were injured at home, six at school. and four outside the home. The seizures causing the injuries were tonic-clonic (17). complex partial (four), myoclonic (one), and of uncertain type (three). None of the 32 patients with childhood-onset typical absence epilepsy had accidental injuries. Conclusions: Injuries caused by epileptic seizures were uncommon in this newly diagnosed and untreated, consecutive paediatric Outpatient series. These unique data could help to reassure clinicians that the diagnosis of epilepsy should not be influenced by any concern that accidental injuries caused by seizures are common in children before starting medication.