Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy
Epilepsy-related injuries and accidents (ERIA) are a frequent cause of hospitalisation and represent a relevant burden for patients with epilepsy. In particular, osteoporosis and other gender-specific aspects may increase the risk of seizure-related fractures and injuries in women with epilepsy.
Aim and scope
The aim of this analysis is to determine the prevalence and clinical nature of ERIA in a cohort of women with epilepsy, to identify possible determinants including osteoporosis and to give an overview of the current knowledge of clinically important prophylactic and therapeutic aspects.
In total, 167 women (mean age 39.0 years, range 18–67 years) with established diagnosis of epilepsy (mean disease duration 18.2 years, range 0–64) were analysed for the occurrence of ERIA. Overall, 22 patients (13.2%) reported at least one ERIA (mean number 3.4, ± 3.1) during the last three months prior to enrollment. The most frequent types of ERIA were lacerations (n = 7/22; 31.8%), abrasions, cuts, bruises or hematoma (n = 6/22, 27.3%), burns (n = 3/22, 13.6%), and fractures (n = 3/22, 13.6%). Moreover, one seizure-related road traffic accident with consecutive trauma (4.5%) was reported. Ictal falls, periictal abnormalities of behaviour and missing seizure freedom were associated with ERIA. Furthermore, female patients with ERIA had a significantly reduced quality of life (QoL, p = 0.002) and increased anxiety (p = 0.008) compared to patients without ERIA. A review of the pertinent literature suggests decreased bone mineral density and use of enzyme-inducing AEDs to be risk factors for ERIA in women with epilepsy.
ERIA represent relevant complications for women with epilepsy and are associated with a lower QoL and anxiety compared with non-affected controls. Improvement of anticonvulsive treatment and therapy for osteoporosis or osteomalacia may help to decrease ERIA and the associated burden.
KeywordsSeizure Female Fracture Burden Quality of life Osteoporosis
MRI and CT scans were provided with kind permission of Prof. Dr. Marlies Wagner, Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany.
RDV and LMW developed the idea for this project and performed the statistical analysis. RDV, NS, IM, SK, EP, FR, AS and LMW wrote the paper. Each author contributed important content-related aspects.
Compliance with ethical standards
Conflict of interest
R. D. Verboket, E. Paule, N. Söhling, L. M. Willems report no conflicts of interest. I. Marzi reports personal fees and grants from AO-foundation and Deutsche Forschungsgemeinschaft. S. Knake reports honoraria for speaking engagements from Desitin and UCB as well as educational grants from AD Tech, Desitin Arzneimittel, Eisai, GW, Medtronic, Novartis, Siemens and UCB. F. Rosenow reports personal fees from Eisai, UCB, Desitin Arzneimittel, Novartis, Medtronic, Cerbomed, Sandoz, GW-Pharma, BayerVital and Shire, grants from the European Union, Deutsche Forschungsgemeinschaft and the Detlev-Wrobel-Fonds for Epilepsy research. A. Strzelczyk reports personal fees and grants from Desitin Arzneimittel, Eisai, LivaNova, Sage Therapeutics, UCB Pharma and Zogenix.
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