Dubost J J, Vernay D, Soubrier M, Cauhape P, Bussière J L, Sauvezie B
Unité d'Immunologie clinique Hôpital Saint-Jacques, Clermont-Ferrand.
Rev Med Interne. 1993 May;14(5):294-6. doi: 10.1016/s0248-8663(05)81302-5.
Epileptic seizures can produce dislocations or fractures of the limbs and vertebral compression fractures. We tried to determine the clinical and radiological features of the latter in 8 patients: 6 men and 2 women including one aged only 41 years. The often multiple compression fractures involved the first thoracic (n = 3) and the intermediate thoracic (n = 3) or lower lumbar (n = 2) vertebrae but, contrary to common osteoporosis, never the thoracolumbar hinge. In 2 cases, the appearance of the fracture and the neurological signs led to surgery. Posterior dislocation of the shoulder was associated with the fractures in 2 cases. Chronic alcoholism (4 cases), anti-epileptic drugs (1 case) or corticosteroids (1 case) might have facilitated a demineralization which was however not obvious on X-ray films. The seizure was a first ever event in 6 cases. In the absence of controls the fracture was considered to be spontaneous. These particularities explain why a metastatic compression fracture was initially suspected in 3 cases, leading to explorations which sometimes were aggressive. In the presence of a suspicious vertebral compression fracture the clinician must consider the possibility of an epileptic seizure, a trauma which is sufficient to explain the fracture, as shown by the complications of electro-convulsive therapy.
癫痫发作可导致肢体脱位或骨折以及椎体压缩性骨折。我们试图确定8例患者中后者的临床和放射学特征：6名男性和2名女性，其中1名仅41岁。多发性压缩性骨折常累及第一胸椎（n = 3）、胸椎中段（n = 3）或腰椎下段（n = 2），但与常见的骨质疏松症不同，从未累及胸腰段交界处。2例患者因骨折表现及神经体征而行手术治疗。2例患者的骨折伴有肩关节后脱位。慢性酒精中毒（4例）、抗癫痫药物（1例）或皮质类固醇（1例）可能促使骨质脱矿，但在X线片上并不明显。6例患者癫痫发作均为首次发作。由于缺乏对照，骨折被认为是自发性的。这些特殊情况解释了为什么3例患者最初怀疑为转移性压缩性骨折，从而导致有时是侵入性的检查。当存在可疑的椎体压缩性骨折时，临床医生必须考虑癫痫发作的可能性，即足以解释骨折的一种创伤，如电休克治疗的并发症所示。
