Do Cognitively Normal Children With Epilepsy Have a Higher Rate of Injury Than Their Nonepileptic Peers?

The objective of this study was to determine if cognitively normal children with epilepsy have higher accidental injury rates than their age- and sex-matched friends without epilepsy and what factors may predict this. Patients 5 to 16 years old, with a developmental quotient >70, without major motor or sensory impairments, with a 1-year history of epilepsy and who either had a seizure or had been on antiepileptic drugs within the past year, were identified from the pediatric neurology database of the Royal University Hospital. Twenty-five of 31 cases and their best friend controls agreed to participate. Seizure-related factors including type, duration, frequency, timing, date of diagnosis, antiepileptic drug initiation and discontinuation, and specific types and total antiepileptic drugs used were assessed by interview. Questionnaires about accidental injury including type, number, severity, and, if applicable, injuries resulting from seizures, as well as general safety practices, activity restrictions, and presence of attention-deficit hyperactivity disorder, were completed by cases and controls. No significant differences in injury numbers (specific types or total) or severity were found, although a small number of epileptic children were very predisposed to injury. Seizure-related factors did not predict injury in cases. Safety practices were similar, and restrictions in cases were not excessive. Children with attention-deficit hyperactivity disorder had a higher injury rate, both in cases and controls. Cognitively normal children with epilepsy do not have a higher injury rate than their nonepileptic peers. If consciousness is impaired in seizures, extra supervision for swimming and bathing and restricted climbing heights are suggested. All other safety restrictions for epileptic children should follow those appropriate to nonepileptic children to allow a normal lifestyle. (J Child Neurol 2001;16:100-104).