Seizure-related injuries are underreported in pharmacoresistant localization-related epilepsy

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Friedman DE and Gilliam FG (2009) Seizure-related injuries are underreported in pharmacoresistant localization-related epilepsy.

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Abstract: PURPOSE: To investigate and compare injury rates, associated risk factors, circumstances, and medical record documentation in patients with pharmacoresistant temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). METHODS: The study cohort consisted of fifty-two consecutive adults with treatment-resistant epilepsy and seizure classification confirmed by video-electrocardiography (EEG) (28 with TLE and 24 with ETLE) who consented to participate. All subjects had their seizures classified with prior video-EEG monitoring, were followed in a tertiary-care center in northwest New York City, and received a semistructured phone interview regarding injuries experienced since being diagnosed with epilepsy. RESULTS: Injuries were reported in 16 (57%) of the patients with TLE and 4 (17%) of the patients with ETLE (p = 0.004 after controlling for duration of epilepsy and seizure burden); 83% of all injuries were designated by patients as seizure-related. Most injuries (22 of 41; 54%) were classified as moderate or greater in severity. In addition, one motor vehicle accident (MVA) was reported in the TLE group and one episode of sudden unexpected death (SUDEP) was identified in the ETLE group. More than half (55%) of the injuries were not documented as seizure-related in medical records. CONCLUSION: A substantial number of potentially serious injuries are not documented as seizure related, even in a tertiary-care setting. Patients with pharmacoresistant TLE may be at higher risk for experiencing an injury than patients with pharmacoresistant ETLE.

Keywords: Temporal lobe epilepsy, Extra-temporal lobe epilepsy, Injury


  • Cohort study of 52 adults with refractory epilepsy, approximately half of whom had temporal lobe epilepsy and half extratemporal, in a tertiary care setting. There was a trend for patients with temporal lobe epilepsy to have a higher injury risk. One case of SUDEP occurred in the extratemporal epilepsy group. The telephone interviews with patients showed that injuries are substantially underreported in physician charts.