Seizure disorders and trauma.

The prevalence of seizure disorder diagnosis in the general population is between 0.5% and 2.0%. Seizures may be manifested by abnormal motor activity, loss of muscle tone, and changes in mental status. Seizure may increase an individual's risk for traumatic injury by adversely influencing performance in a particular situation. We identified 30 patients admitted to our trauma service over a three-year period with injury related to seizure; 16 were male and 14 were female, with a mean age of 34.8 years. Twenty-eight patients (93%) had a history of seizure activity, with the mean duration of seizure activity of 16.5 years (range, three to 40 years). Both seizure diagnosis and etiology were multifactorial. Multiple drug therapy predominated, phenytoin (Dilantin) being the most frequently used medication. Overall compliance was poor (53%). Only blunt injury occurred in these patients, 50% suffering injury from falls. Injuries from motor vehicle accidents (40%) were the next most frequent (auto crash in seven cases, motorcycle crash in four, and bicycle crash in one case). The remainder of the injuries were burns (10%). Nine patients (30%) required operation. Skeletal injuries predominated (67%). Patients with a history of seizure will be frequently encountered by physicians of all specialties. The patients likely to be at increased risk for injury are noncompliant, have breakthrough seizures (ie, despite therapy), or have the metabolism of their seizure medication altered by alcohol or other drugs. To prevent potentially serious injury, these patients should be identified and counseled.