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Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Results

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.

Conclusion

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.

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References

  1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.

    Article  Google Scholar 

  2. Strzelczyk A, Reese JP, Dodel R, Hamer HM. Cost of epilepsy: a systematic review. Pharmacoeconomics. 2008;26(6):463–76.

    Article  Google Scholar 

  3. Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, et al. Incidence, risk factors and consequences of epilepsy-related injuries and accidents: a retrospective, single center study. Front Neurol. 2018;9:414. https://doi.org/10.3389/fneur.2018.00414.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Camfield C, Camfield P. Injuries from seizures are a serious, persistent problem in childhood onset epilepsy: a population-based study. Seizure. 2015;27:80–3. https://doi.org/10.1016/j.seizure.2015.02.031.

    Article  PubMed  Google Scholar 

  5. Strzelczyk A, Hermsen A, Oertel WH, Knake S, Rosenow F, Hamer HM. Risk factors and incidence of epilepsy-related injuries an accidents. Nervenheilkunde. 2014;2014(33):331–4.

    Google Scholar 

  6. Kwon CS, Liu M, Quan H, Wiebe S, McChesney J, Wirrell E, et al. The incidence of injuries in persons with and without epilepsy—a population-based study. Epilepsia. 2010;51(11):2247–53. https://doi.org/10.1111/j.1528-1167.2010.02697.x.

    Article  PubMed  Google Scholar 

  7. Willems LM, Richter S, Watermann N, Bauer S, Klein KM, Reese JP, et al. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013—a ten-year overview. Epilepsy Behav. 2018;83:28–35. https://doi.org/10.1016/j.yebeh.2018.03.025.

    Article  PubMed  Google Scholar 

  8. Lagunju IA, Oyinlade AO, Babatunde OD. Seizure-related injuries in children and adolescents with epilepsy. Epilepsy Behav. 2016;54:131–4. https://doi.org/10.1016/j.yebeh.2015.11.019.

    Article  PubMed  Google Scholar 

  9. Mahler B, Carlsson S, Andersson T, Tomson T. Risk for injuries and accidents in epilepsy: A prospective population-based cohort study. Neurology. 2018;90(9):e779–89. https://doi.org/10.1212/WNL.0000000000005035.

    Article  PubMed  Google Scholar 

  10. Sheth RD, Gidal BE, Hermann BP. Pathological fractures in epilepsy. Epilepsy Behav. 2006;9(4):601–5. https://doi.org/10.1016/j.yebeh.2006.08.003.

    Article  PubMed  Google Scholar 

  11. Wojtys EM, Huston LJ, Boynton MD, Spindler KP, Lindenfeld TN. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sport Med. 2002;30(2):182–8. doi:https://doi.org/10.1177/03635465020300020601.

    Article  Google Scholar 

  12. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512–21. https://doi.org/10.1111/epi.13709.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–30. https://doi.org/10.1111/epi.13670.

    Article  PubMed  Google Scholar 

  14. Elm v. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies (vol 335, pg 806, 2007). Brit Med J. 2008;336(7634):35.

    Google Scholar 

  15. May TW, Pfafflin M, Cramer JA. Psychometric properties of the German translation of the QOLIE-31. Epilepsy Behav. 2001;2(2):106–14. https://doi.org/10.1006/ebeh.2001.0170.

    Article  PubMed  Google Scholar 

  16. Green JM, Kafetsios K, Statham HE, Snowdon CM. Factor structure, validity and reliability of the Cambridge Worry Scale in a pregnant population. J Health Psychol. 2003;8(6):753–64. https://doi.org/10.1177/13591053030086008.

    Article  PubMed  Google Scholar 

  17. Strzelczyk A, Hermsen A, Belke M, Oertel WH, Knake S, Rosenow F, et al. Incidence, hospitalization costs and risk factors of epilepsy-related injuries and accidents. Epilepsia. 2014;55:200-.

    Google Scholar 

  18. Friedman DE, Gilliam FG. Seizure-related injuries are underreported in pharmacoresistant localization-related epilepsy. Epilepsia. 2010;51(1):43–7. https://doi.org/10.1111/j.1528-1167.2009.02170.x.

    Article  PubMed  Google Scholar 

  19. Willems LM, Reif PS, Knake S, Hamer HM, Willems C, Kramer G, et al. Noncompliance of patients with driving restrictions due to uncontrolled epilepsy. Epilepsy Behav. 2018. https://doi.org/10.1016/j.yebeh.2018.04.008.

    Article  PubMed  Google Scholar 

  20. Naik PA, Fleming ME, Bhatia P, Harden CL. Do drivers with epilepsy have higher rates of motor vehicle accidents than those without epilepsy? Epilepsy Behav. 2015;47:111–4. https://doi.org/10.1016/j.yebeh.2015.04.016.

    Article  PubMed  Google Scholar 

  21. Finelli PF, Cardi JK. Seizure as a cause of fracture. Neurology. 1989;39(6):858–60. https://doi.org/10.1212/Wnl.39.6.858.

    Article  CAS  PubMed  Google Scholar 

  22. Strzelczyk A, Griebel C, Lux W, Rosenow F, Reese JP. The burden of severely drug-refractory epilepsy: a comparative longitudinal evaluation of mortality, morbidity, resource use, and cost using German health insurance data. Front Neurol. 2017;8:712. https://doi.org/10.3389/fneur.2017.00712.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rosenow F, Bast T, Czech T, Feucht M, Hans VH, Helmstaedter C, et al. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment. Epilepsia. 2016;57(8):1215–20. https://doi.org/10.1111/epi.13449.

    Article  PubMed  Google Scholar 

  24. Vestergaard P. Epilepsy, osteoporosis and fracture risk—a meta-analysis. Acta Neurol Scand. 2005;112(5):277–86. https://doi.org/10.1111/j.1600-0404.2005.00474.x.

    Article  CAS  PubMed  Google Scholar 

  25. Koppel BS, Harden CL, Nikolov BG, Labar DR. An analysis of lifetime fractures in women with epilepsy. Acta Neurol Scand. 2005;111(4):225–8. https://doi.org/10.1111/j.1600-0404.2005.00399.x.

    Article  CAS  PubMed  Google Scholar 

  26. Svalheim S, Sveberg L, Mochol M, Tauboll E. Interactions between antiepileptic drugs and hormones. Seizure Eur J Epilepsy. 2015;28:12–7. https://doi.org/10.1016/j.seizure.2015.02.022.

    Article  Google Scholar 

  27. Pack AM, Morrell MJ, Marcus R, Holloway L, Flaster E, Done S, et al. Bone mass and turnover in women with epilepsy on antiepileptic drug monotherapy. Ann Neurol. 2005;57(2):252–7. https://doi.org/10.1002/ana.20378.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Petty SJ, O’Brien TJ, Wark JD. Anti-epileptic medication and bone health. Osteoporos Int. 2007;18(2):129–42. https://doi.org/10.1007/s00198-006-0185-z.

    Article  CAS  PubMed  Google Scholar 

  29. Onodera K, Takahashi A, Sakurada S, Okano Y. Effects of phenytoin and/or vitamin K2 (menatetrenone) on bone mineral density in the tibiae of growing rats. Life Sci. 2002;70(13):1533–42.

    Article  CAS  Google Scholar 

  30. Pack AM, Morrell MJ, Randall A, McMahon DJ, Shane E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology. 2008;70(18):1586–93. https://doi.org/10.1212/01.wnl.0000310981.44676.de.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Rosenow F, Hamer H, Bauer S. Valproate and bone metabolism. Z Epiletol. 2005;18:170–3.

    Article  Google Scholar 

  32. Bauer S, Hofbauer LC, Rauner M, Strzelczyk A, Kellinghaus C, Hallmeyer-Elgner S, et al. Early detection of bone metabolism changes under different antiepileptic drugs (ED-BoM-AED)—a prospective multicenter study. Epilepsy Res. 2013;106(3):417–22. https://doi.org/10.1016/j.eplepsyres.2013.06.020.

    Article  CAS  PubMed  Google Scholar 

  33. Kanda J, Izumo N, Kobayashi Y, Onodera K, Shimakura T, Yamamoto N, et al. Treatment with antiepileptic agent perampanel suppresses bone formation and enhances bone resorption: a bone histomorphometric study in mice. J Hard Tissue Biol. 2017;26(4):405–9. https://doi.org/10.2485/jhtb.26.405.

    Article  CAS  Google Scholar 

  34. Ali II, Schuh L, Barkley GL, Gates JR. Antiepileptic drugs and reduced bone mineral density. Epilepsy Behav. 2004;5(3):296–300. https://doi.org/10.1016/j.yebeh.2004.02.005.

    Article  PubMed  Google Scholar 

  35. Hakami T, O’Brien TJ, Petty SJ, Sakellarides M, Christie J, Kantor S, et al. Monotherapy with levetiracetam versus older AEDs: a randomized comparative trial of effects on bone health. Calcified Tissue Int. 2016;98(6):556–65. https://doi.org/10.1007/s00223-016-0109-7.

    Article  CAS  Google Scholar 

  36. Serin HM, Koc ZP, Temelli B, Esen I. The bone mineral content alterations in pediatric patients medicated with levetiracetam, valproic acid, and carbamazepine. Epilepsy Behav. 2015;51:221–4. https://doi.org/10.1016/j.yebeh.2015.06.025.

    Article  PubMed  Google Scholar 

  37. Pack A. Levetiracetam treatment does not result in broken bones. Epilepsy Curr. 2013;13(2):83–4. https://doi.org/10.5698/1535-7597-13.2.83.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ali II, Herial NA, Horrigan T, Kellough L, Tietjen GE. Measurement of bone mineral density in patients on levetiracetam monotherapy. Epilepsia. 2006;47:276.

    Google Scholar 

  39. Strzelczyk A, Steinig I, von Podewils F, Moddel G, Bauer S, Klein KM, et al. Postmarketing experience with brivaracetam in the treatment of epilepsies: a multicentre cohort study from Germany. Epilepsia. 2017;58:160-S.

    Article  Google Scholar 

  40. Willems LM, Bertsche A, Bosebeck F, Hornemann F, Immisch I, Klein KM, et al. Efficacy, retention, and tolerability of brivaracetam in patients with epileptic encephalopathies: a multicenter cohort study from Germany. Frontiers in Neurology. 2018;9:569. https://doi.org/10.3389/fneur.2018.00569.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ertl J, Hapfelmeier J, Peckmann T, Forth B, Strzelczyk A. Guideline conform initial monotherapy increases in patients with focal epilepsy: a population-based study on German health insurance data. Seizure. 2016;41:9–15. https://doi.org/10.1016/j.seizure.2016.07.001.

    Article  PubMed  Google Scholar 

  42. Strzelczyk A, Bergmann A, Biermann V, Braune S, Dieterle L, Forth B, et al. Neurologist adherence to clinical practice guidelines and costs in patients with newly diagnosed and chronic epilepsy in Germany. Epilepsy Behav. 2016;64(Pt A):75–82. https://doi.org/10.1016/j.yebeh.2016.07.037.

    Article  PubMed  Google Scholar 

  43. Teagarden DL, Meador KJ, Loring DW. Low vitamin D levels are common in patients with epilepsy. Epilepsy Res. 2014;108(8):1352–6. https://doi.org/10.1016/j.eplepsyres.2014.06.008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Drezner MK. Treatment of anticonvulsant drug-induced bone disease. Epilepsy Behav. 2004;5:41–7. https://doi.org/10.1016/j.yebeh.2003.11.028.

    Article  Google Scholar 

  45. Lazzari AA, Dussault PM, Thakore-James M, Gagnon D, Baker E, Davis SA, et al. Prevention of bone loss and vertebral fractures in patients with chronic epilepsy—antiepileptic drug and osteoporosis prevention trial. Epilepsia. 2013;54(11):1997–2004. https://doi.org/10.1111/epi.12351.

    Article  CAS  PubMed  Google Scholar 

  46. Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Prz Menopauzalny. 2014;13(4):213–20. https://doi.org/10.5114/pm.2014.44996.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Harden CL, Herzog AG, Nikolov BG, Koppel BS, Christos PJ, Fowler K, et al. Hormone replacement therapy in women with epilepsy: a randomized, double-blind, placebo-controlled study. Epilepsia. 2006;47(9):1447–51. https://doi.org/10.1111/j.1528-1167.2006.00507.x.

    Article  CAS  PubMed  Google Scholar 

  48. Crawford P, Serrano EA, Sazgar M. Bone health in women with Epilepsy. In: Sazgar M, Harden C, editors. Controversies in caring for women with epilepsy. Cham: Springer; 2016.

    Google Scholar 

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Acknowledgements

MRI and CT scans were provided with kind permission of Prof. Dr. Marlies Wagner, Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt am Main, Germany.

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    René Danilo Verboket, Nicolas Söhling & Ingo Marzi

  2. Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany

    Esther Paule, Felix Rosenow, Adam Strzelczyk & Laurent Maximilian Willems

  3. Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany

    Susanne Knake, Felix Rosenow & Adam Strzelczyk

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  1. René Danilo Verboket
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  2. Nicolas Söhling
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Contributions

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.

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Correspondence to René Danilo Verboket.

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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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Verboket, R.D., Söhling, N., Marzi, I. et al. Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy. Eur J Trauma Emerg Surg 45, 375–381 (2019). https://doi.org/10.1007/s00068-018-1030-8

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