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Seizure-Related Injuries High in Epilepsy, Show Potential Quality of Life Strains

People with epilepsy were less involved than controls in activities considered risky, such as driving and doing household chores, which may have suggested reduced social independence and legal limitations for driving.

Recently published data showed that the frequency of seizure-related injuries is high, both since the onset of epilepsy and in the previous year, in adults with chronic epilepsy, prompting the need for improved guidelines on seizure control and preventive measures for risky activities.1

The prospective study included 72 adults with epilepsy, of which 55 (76.3%) reported cases of seizure-related injuries suffered throughout their lifespan and 17 (23.6%) in the previous year. Throughout the lifespan, seizure-related injuries occurred more frequently in younger people with epilepsy, in those using more than 1 antiseizure medication, and in individuals who were younger at the time of the onset of epilepsy.

Lead investigator Barbara de Almeida Fischer, MD, department of neurology, Pontifical Catholic University of Campinas, and colleagues aimed to understand the occurrence of these injuries, as well as their relationship with clinical variables. The practice of activities considered at risk of accidents (driving cars, riding bicycles or skateboards, working with dangerous machinery and equipment, and cooking or ironing) were compared between those with epilepsy and the control group (CG). The CG consisted of individuals of equivalent age, gender, and sociocultural conditions, with no history of chronic diseases.

To assess the occurrence of seizure-related injuries since the onset of epilepsy and in the previous year, patients completed a specific questionnaire that included several instruments such as the Seizure Severity Questionnaire (SSQ), Mini-Mental State Examination, and Quality of Life in Epilepsy Inventory (QOLIE-13). The SSQ included 2 numerical measures: the degree of severity of seizures, with a score ranging from 0 to 7 (mild to severe) and the global assessment (total score), which is measured using 13 items from a Likert scale, with a score between 0 and 91. The CG individuals were asked about demographic data and about the practice of activities with risk of accidents.

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Results showed that the occurrence of seizure-related injuries was significantly associated with higher SSQ scores, both on total score and seizure severity, whereas there was no found relationship between seizure-relayed injuries and the QOLIE-31 scores. Additionally, all patients with epilepsy who were injured in the previous year had sustained injuries in the year prior to the year before the conduct of the study. A high number of previous injuries was associated with an increased risk of subsequent injuries throughout a patients’ lifespan.

During the previous year, it was observed that seizure-related injuries occurred in those with a higher frequency of seizures, in the youngest individuals in the sample, with lower scores in the QOLIE-31 and with a perception of greater severity of seizures, according to the SSQ. There was no relationship between the occurrence of injuries during the previous year and other demographic or clinical aspects.

In terms of injuries associated with risky activities, those with epilepsy were less likely to have driver licenses (chi-square test, 16 [22.2%] vs 39 [65%]; P <.001), do less household chores such as cooking (45 [62.5%] vs 50 [83.3%]; P = .008) and ironing (39 [54.1%] vs 43 [71.6%]; P = .039), with no differences in the practice of other activities observed. Of those with epilepsy, 11 individuals (20%) had seizure-related injuries associated with risk activities. These patients had a longer mean length of seizure disorder and required more surgical procedures; however, there was no relationship between injuries related to risky activities, the total number of seizure-related injuries, and other epilepsy variables.

REFERENCE
1. Almeida Fischer B, Tedrus GM. Seizure-related injuries in adults: a prospective case-controlled study on risk factors, seizure severity, and quality of life. Epilep & Behav. Published online July 26, 2022. doi:10.1016/j.yebeh.2022.108849