Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures

Abstract

Objective To evaluate the incidence and risk factors of generalized convulsive seizure (GCS)-related fractures and injuries during video-EEG monitoring. Methods We analyzed all GCSs in patients undergoing video-EEG-monitoring between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg in relation to injuries, falls and accidents associated with GCSs. Data were gathered using video material, EEG material, and a standardized reporting form. Results A total of 626 GCSs from 411 patients (mean age: 33.6 years; range 3–74 years; 45.0% female) were analyzed. Severe adverse events (SAEs) such as fractures, joint luxation, corneal erosion, and teeth loosening were observed in 13 patients resulting in a risk of 2.1% per GCS (95% CI 1.2–3.4%) and 3.2% per patient (95% CI 1.8–5.2%). Except for a nasal fracture due to a fall onto the face, no SAEs were caused by falls, and all occurred in patients lying in bed without evidence of external trauma. In seven patients, vertebral body compression fractures were confirmed by imaging. This resulted in a risk of 1.1% per GCS (95% CI 0.5–2.2%) and 1.7% per patient (95% CI 0.8–3.3%). These fractures occurred within the tonic phase of a GCS and were accompanied by a characteristic cracking noise. All affected patients reported back pain spontaneously, and an increase in pain on percussion of the affected spine section. Conclusions GCSs are associated with a substantial risk of fractures and shoulder dislocations that are not associated with falls. GCSs accompanied by audible cracking, and resulting in back pain, should prompt clinical and imaging evaluations.

Injury protection strategies for H63D syndrome patients suffering from cataplexy

“…broken bones). [18][19][20] The following results are average values per patient (related to a defined month):…”

“…Putative concerns about the patient's well-being (e.g., fear of stigmatization or mobility in daily life) are soft factors that should not be a contraindication. [8][9][10][11][12][13][14][15][16][17][18]20 A good half of the wheelchair users even had stronger leg and back muscles after a year in their wheelchairs, without any walking, thanks to supervised physiotherapy.…”

Non-Traumatic Tile Type B3 Pelvic Fracture Combined With Garden Type III Femoral Neck Fracture Caused By Hypocalcaemia-Induced Convulsions

“…Among these, 0.3% of the fractures were directly associated with convulsive seizures and without additional trauma. Frey et al analyzed 411 patients between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg, where 6 patients sustained fractures with no obvious injuries [3] . Salas-Puig et al observed 406 patients with generalized seizures; the rate of accidental fracture associated with generalized seizures was 3.9% [4] .…”

Bilateral mandibular head fractures associated with convulsion

“…2 In the recent study, severe adverse events such as fractures, joint luxation, corneal erosion and teeth loosening were observed in 2.1% per generalised convulsive seizure. 3 However, few reports of mandibular fractures as single convulsion, there is a report that refractory epilepsy may be associated with dentoalveolar and mandibular fractures. 4 A systematic review about bone fractures from generalised convulsive seizures reported that the shoulders' fractures were most frequently described (33%) and followed by thoracic and lumber vertebral compression fractures (29%), skull and jaw fractures (8%) and bilateral femoral neck fractures (6%).…”