ACCIDENTAL INJURY IS A SERIOUS RISK IN CHILDREN WITH TYPICAL ABSENCE EPILEPSY

Objectives: To determine if young adults with a history of typical abs ence epilepsy (AE) in childhood have a greater risk of accidental inju ry than controls with juvenile rheumatoid arthritis (JRA). To assess t he nature and severity of these injuries. Methods: All patients with A E or JRA diagnosed between 1977 and 1985, who were 18 years or older a t the onset of the study, were identified from review of pediatric ele ctroencephalographic records for the province of Nova Scotia (AE) or r eview of the medical records database at the only tertiary care pediat ric center for the province (JRA). Fifty-nine (86%) of 69 patients wit h AE and 61 (80%) of 76 patients with JRA participated in an interview in 1994 or 1995, assessing nature, severity, and treatment of prior a ccidental injuries. Patients with AE were further questioned about inj uries sustained during an absence seizure. Results: Sixteen (27%) of 5 9 patients with AE reported accidental injury during an absence seizur e, with the risk of injury being 9% per person-year of AE. Most injuri es (81%) occurred during anti-epileptic drug therapy. Although the maj ority of injuries did not require treatment, 2 (13%) of 16 patients re quired minor treatment and 2 (13%) of 16 were admitted to hospital. Th e risk of accidental injury resulting from an absence seizure in perso n-years at risk was highest in juvenile myoclonic epilepsy (45%), mode rate in juvenile AE (14%), and lowest in childhood AE (3%). Patients w ith AE had a greater number of overall accidental injuries than those with JRA (P<.04), but these differences were particularly marked for b icycle (P<.003) and car accidents (P<.05) and for mild head injuries ( P=.05). Conclusions: Accidental injury is common in AE and usually occ urs after anti-epileptic drug treatment is started. Injury prevention counseling is indicated both at diagnosis and follow-up. Bicycle accid ents pose a special risk and helmet use should be mandatory.