Prof D’Souza
Patients’ perceptions of warnings before seizures do not protect them from seizure-related injury.
The findings from an Australian study emphasise the importance of total freedom from seizures in order to maximise the safety of patients with epilepsy.
Tasmanian Epilepsy Register data from over 800 patients show that about 10% of patients had a seizure‐related injury in the previous 12 months. Almost half the patients (43%) reported seizure-related injuries over their lifetime.
They were mostly immersions, head injuries, driving incidents, burns, fractures and dental injuries such as lost teeth, fractured jaws and major dental surgery.
Seizure-related immersions were more likely to occur at home while showering or bathing than in other settings.
The study found injury risk increased with the frequency of seizures and warnings of an impending seizure were not protective.
Associate Professor Wendyl D’Souza, head of epilepsy services at St Vincent’s Hospital Melbourne, told the limbic control of seizures was the only way to avoid associated injuries.
“Any seizures are a risk factor and I think that was one of the highlights of the paper – that the worse your seizure control is the more likely you are to have injuries.”
“But even having a seizure once a year puts you at risk of having an injury and in some respects that is because of the nature of epilepsy – seizures occur unpredictably.”
Professor D’Souza said some reliable mechanism of seizure prediction would allow patients to be safe by restricting activities such as swimming or ensuring supervision while bathing or showering.
But the issue of patients saying they had warnings before seizures was challenging.
“One of the major dilemmas is that patients say they will have time to make themselves safe – get out of the bath or pull the car over – but what is interesting about this data is that warning does not reduce the chance of injury. In the majority of seizures, you don’t get a warning.”
“A warning can be immediately before, in the hours leading up to or a few days before a seizure.”
“Thinking you will get a warning can be negative, because you think you are doing that all the time and it doesn’t happen. Warnings are not an indicator that you are going to be safe for all your seizures.”
“Whether the warning of a seizure is there or not, it may not be there all the time.”
Professor D’Souza said research and clinical practice needs to strive towards making people seizure free or being able to better predict when a seizure may happen.
Work that was progressing on predicting seizures on the basis of features such as EEG, heart rate and respiration rate may also be useful in understanding sudden unexplained deaths in epilepsy.