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Head first - Review of epilepsy head injury risk and protection.

Authors
  • Jory, Caryn1
  • Oak, Katy2
  • Organ, Catriona2
  • Mclean, Brendan2
  • Shankar, Rohit3
  • 1 Cornwall Partnership NHS Foundation Trust, Chy Govenek, Three Milestone Industrial Estate, Truro, TR4 9LD, Cornwall, UK.
  • 2 Royal Cornwall Hospital Trust, Truro, TR1 3LQ, Cornwall, UK.
  • 3 Cornwall Partnership NHS Foundation Trust, Chy Govenek, Three Milestone Industrial Estate, Truro, TR4 9LD, Cornwall, UK; Exeter Medical School Knowledge Spa, TR1 3LQ, Cornwall, UK. Electronic address: [email protected]
Type
Published Article
Journal
Seizure
Publication Date
Jun 12, 2019
Volume
71
Pages
66–79
Identifiers
DOI: 10.1016/j.seizure.2019.06.013
PMID: 31207395
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The causes of falls and resultant head injuries in people with epilepsy are complex and represent important clinical issues significantly impacting on safety, quality of life and long-term prognosis. A general solution for many years has been to provide helmets for head protection. There is poor understanding of the influencing risk factors and solutions to give person-centred clinical advice. A focused narrative review was conducted to investigate the risk factors for seizure-related head injuries and evidence of current helmets to offer protection. Four databases were searched (Embase, Medline, PsycInfo and Cochrane Library) using combinations of text words and thesaurus terms for the retrieval of articles relating to seizure-related head injury. Articles for full analysis were selected by a ten item pre-defined inclusion criteria. Of 104 relevant studies longlisted 21 studies met four or more of the predefined criteria and included in this review. A further nine papers were included because they added additional relevant information. Seizure-related head injury, although rare, may have serious consequences. High doses of antiepileptic/antiseizure drugs (AEDs/ASDs) and a prescription for three or more AEDs/ASDs are significant, modifiable, risk factors for head injury. Differentiating confusion due to post-ictal changes or concussion can be challenging. Seizure-related cardiac causes leading to injury due to ictal bradycardia or asystole is under investigated. More research is required to validate the protective benefit of various helmet designs in seizure-related head injury. It is striking that there are no International Standards for protective helmets in seizures. Copyright © 2019 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

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