Risk factors for injury in a community‐treated cohort of patients with epilepsy in Australia

Tan, Michael L.; Boston, Ray; Cook, Mark; D’Souza, Wendyl

doi:10.1111/epi.14659

Cited by 10 publications

(7 citation statements)

References 39 publications

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“…Additionally, injuries during seizures were frequently observed, with a rate of up to 56% in the community-based studies. This is much higher than studies in high-income countries suggest [32,33] and also is a possible explanation for high epilepsy-associated mortality rates in LMIC [34].…”

Section: Discussionmentioning

confidence: 63%

Characteristics of people with epilepsy in three Eastern African countries – a pooled analysis

et al. 2022

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Background Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. Methods We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. Results Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15–32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic–clonic seizures (70–85%). Only 67–78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). Conclusions Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.

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Section: Discussionmentioning

confidence: 63%

Characteristics of people with epilepsy in three Eastern African countries – a pooled analysis

et al. 2022

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“…The most consistent findings regarding risk factors for injuries are occurrence of generalized convulsive seizures (focal to bilateral or generalized tonic-clonic seizures) 21,22,30,33 , but atonic seizures and ictal falls have also been associated with increased risks 21,33,34 . Intractable epilepsy, uncontrolled seizures, or high seizure frequency are also consistent risk factors for seizure-related injuries [21][22][23]31,35 . Polytherapy with AEDs was reported to be associated with increased risk in a few studies 21,31,34 although it is not clear if polytherapy is a risk factor as such or just a reflection of a more difficult to treat epilepsy with poor seizure control.…”

Section: Risk Factorsmentioning

confidence: 94%

“…In a retrospective community-based study of 819 patients with epilepsy from Tasmania, 10% reported experiencing an injury in the preceding year 22 . In the population-based childhood onset epilepsy cohort in Nova Scotia, 52 of 472 patients (11%) reported having experienced at least one serious injury during an average follow up of 24 years 23 .…”

Section: Injuries In People With Epilepsymentioning

confidence: 99%

Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality

Mesraoua

Deleu

Hassan

et al. 2020

Current Medical Research and Opinion

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In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.

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“…Need help to identify their normal seizure pattern, when a situation is an emergency, and how to respond [30,44] Have intractable epilepsy syndromes (i.e., Lennox-Gastaut, Dravet) Have frequent nocturnal generalized tonic-clonic seizures or generalized seizure and greater risk of sudden unexpected death in epilepsy with nocturnal convulsions Require support for maintaining dignity and independence [30] and alleviating fear of having a seizure at any time [5] Require guidance for prevention of an injury [45] Are in a group that may have special concerns (e.g., young children, older adults, patients with developmental disabilities) [12] Are at high risk for seizure clusters [48] Live far from medical care or in assisted living [ [39], as well as their own burden related to epilepsy (e.g., effect on the ability to work, travel, and take part in social activities) [5] Need empowerment to address mental health issues (e.g., depression) associated with caregiving [49] 3.3.3. In the home Babysitters, grandparents, and other infrequent caregivers will benefit from an ASAP's guidance if a seizure occurs when the patient is in their care.…”

Section: Patients Whomentioning

confidence: 99%

“…It can educate and allow effective recognition of usual versus unusual patterns [39,44]. Injury risk assessment and prevention strategies [45] may be addressed by the ASAP. The ASAP may provide guidance in isolated geographic areas [37], in assisted living facilities [37], and for pre-hospital emergency personnel [39].…”

Section: When To Use the Asapmentioning

confidence: 99%

Recommendations for development of acute seizure action plans (ASAPs) from an expert panel

Penovich¹,

Glauser²,

Becker³

et al. 2021

Epilepsy & Behavior

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Purpose of review: Disease-related treatment action plans for acute exacerbations providing information that may be helpful for self-management for patients and caregivers are commonly used for chronic conditions such as asthma and diabetes. However, among patients with epilepsy, a review of the literature suggested that the majority did not have an action plan in place for acute seizure treatment. Recent findings: Currently, there is a lack of unified guidance on seizure action plans (SAPs) in the literature. In the authors' opinion, available formats have limitations for practical use and may not be easily customizable to individual patients, and they are not often designed to provide simple-to-follow steps for rapid immediate steps to determine and initiate appropriate treatment of seizure emergencies. Our group reviewed current examples of SAPs and provided guidance on the development of acute seizure action plans (ASAPs) designed to facilitate rapid, appropriate acute care in the community and to be as useful as possible for a wide range of care partners, including those with limited experience. Summary: This paper provides agreed upon expert opinion recommendations and considerations for goals, development process, types of content, and format for an ASAP.

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Risk factors for injury in a community‐treated cohort of patients with epilepsy in Australia

Cited by 10 publications

References 39 publications

Characteristics of people with epilepsy in three Eastern African countries – a pooled analysis

Characteristics of people with epilepsy in three Eastern African countries – a pooled analysis

Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality

Recommendations for development of acute seizure action plans (ASAPs) from an expert panel

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