Wirrell Elaine C
Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
Epilepsia. 2006;47 Suppl 1:79-86. doi: 10.1111/j.1528-1167.2006.00666.x.
Only one prospective, controlled study has compared the risk of accidental injury in persons with epilepsy to controls without seizures. A mildly increased risk in the epilepsy group was found, predominantly due to injuries that result directly from a seizure. With regard to injury type, this study found significantly higher rates of only head and soft tissue injury; however, most injuries were minor. Several retrospective, population-based studies have suggested increased rates of more serious injury types. Submersion injury has a high mortality; the risk of submersion in children with epilepsy is 7.5-13.9 fold higher than in the general population. The risk of fracture is elevated approximately twofold, either resulting directly from seizure-induced injury or predisposed by drug-induced reduction in bone mineral density. Burns due to seizures account for between 1.6% and 3.7% of burn unit admissions. The risk of motor vehicle accidents in drivers with epilepsy also appears increased, albeit marginally. Several factors predispose to a higher risk of injury among those with epilepsy. Seizures resulting in falls increase the risk of concussion and other injuries. Higher seizure frequency, lack of a prolonged seizure-free interval, comorbid attention deficit disorder, or cognitive handicap may also increase the risk of injury. While some restrictions are necessary to protect the safety of the person with epilepsy, undue limitations may further limit achievement of independence. Given the high morbidity and mortality of submersion injury, those with active epilepsy should bathe or swim only with supervision; however, showering is a reasonable option. Appropriate vitamin D and calcium supplementation and periodic measurement of bone mineral density in those at risk for osteopenia are recommended.
仅有一项前瞻性对照研究比较了癫痫患者与无癫痫发作的对照人群发生意外伤害的风险。研究发现癫痫组的风险略有增加，主要是由于癫痫发作直接导致的损伤。关于损伤类型，该研究发现仅头部和软组织损伤的发生率显著更高；然而，大多数损伤并不严重。几项基于人群的回顾性研究表明，更严重损伤类型的发生率有所增加。溺水损伤的死亡率很高；癫痫患儿溺水的风险比普通人群高7.5至13.9倍。骨折风险大约升高两倍，这要么是由癫痫发作引起的损伤直接导致的，要么是由药物引起的骨矿物质密度降低所致。癫痫发作导致的烧伤占烧伤科入院病例的1.6%至3.7%。癫痫患者驾驶机动车时发生事故的风险似乎也有所增加，尽管幅度较小。有几个因素使癫痫患者更容易受到更高的伤害风险。癫痫发作导致跌倒会增加脑震荡和其他损伤的风险。癫痫发作频率较高、无长时间无癫痫发作间隔、合并注意力缺陷障碍或认知障碍也可能增加受伤风险。虽然为保护癫痫患者的安全有必要进行一些限制，但过度限制可能会进一步限制其独立性的实现。鉴于溺水损伤的高发病率和高死亡率，有活动性癫痫的患者应仅在有人监督的情况下洗澡或游泳；然而，淋浴是一个合理的选择。建议对有骨质疏松风险的人适当补充维生素D和钙，并定期测量骨矿物质密度。
