PDF《Epilepsia, 45(6):667–672, 2004》

Epilepsia, 45(6):667C672,

2004 Blackwell Publishing, Inc.

C

2004 International League Against Epilepsy Accidents in Patients with Epilepsy: Types, Circumstances, and Complications: A European Cohort Study Mariska van den Broek and Ettore Beghi for the RESt-1 Group Summary: Purpose: To investigate the risk of accidents in a cohort of patients with epilepsy and in matched nonepilepsy controls, by type, circumstances, and complications. Methods: A total of

951 children and adults with idiopathic, cryptogenic, or remote symptomatic epilepsy and

904 matched controls seen in secondary and tertiary centers in eight European countries (England, Estonia, Germany, Italy, the Netherlands, Portugal, Russia, and Slovenia) were followed up prospectively for 17,484 and 17,206 person-months and asked to report any accident requiring medical attention, its site, and complications. Risk assessment was done by using actuarial methods, relative risks (RRs), and 95% confidence intervals (CIs). Results: During the study period,

199 (21%) patients and

123 (14%) controls reported an accident (p <

0.0001);

24% were seizure related. The cumulative probability of accidents at

12 and

24 months was

17 and 27% in the cases and

12 and 17% in the controls. The risk was highest for concussions (RR, 2.6;

95% CI, 1.2C5.8), abrasions (RR, 2.1;

95% CI, 1.1C4.0), and wounds (RR, 1.9;

CI, 1.2C3.1). Domestic accidents prevailed in both groups, followed by street and work accidents, and were more common among cases. Compared with controls, patients with epilepsy reported more hospitalization, complications, and medical action. Disease characteristics associated with an in- creased risk of accidents included generalized epilepsy (concus- sions), active epilepsy, and at least monthly seizures (abrasions). Most risks decreased, becoming nonsignificant after excluding seizure-related events. Conclusions: Patients with epilepsy are at higher risk of ac- cidents and their complications. However, the risk was sub- stantially lower after exclusion of seizure-related events. Key Words: Epilepsy―Accidents―Injuries. Patients with epilepsy are commonly thought to be at higher risk for accidents than the general population. This assumption is based on a number of clinical reports (1). However, these reports provide conflicting results in terms of the overall risk of accidents and the proportion of risk at- tributable to epilepsy. This contradictory information may be explained by differences in the study populations and in the study design and methods. For these reasons, a mul- ticenter European cohort study was undertaken in patients with epilepsy and matched controls to assess the relative risk of accidents over a limited period. The overall risk of accidents in our study population has been reported elsewhere (2). In this study, the risk is illustrated by type, circumstances, and complications. MATERIAL AND METHODS This population was recruited in eight European coun- tries (Estonia, Germany, Italy, the Netherlands, Portugal, Russia, Slovenia, and the United Kingdom). This wide collaboration was required to recruit a large sample of pa- Accepted December 20, 2003. Address correspondence and reprint requests to Dr. E. Beghi at Isti- tuto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62,

20157 Milano, Italy. E-mail: [email protected] tients in a relatively short time and to compare different sociocultural settings. The centers included university and general hospitals, each with adequate experience, tech- nology, and qualifications for the management of patients with epilepsy. Details of the study methods and design can be found elsewhere (3). In brief, to be recruited, the patients had to be