Prognosis The patients prognosis for disability and for a recurrence of epileptic seizures depends on the type of epileptic seizure and the epileptic syndrome in question. Impairment of consciousness during a seizure may unpredictably result in morbidity or even mortality. Regarding morbidity, trauma is not uncommon among people with generalized tonic-clonic seizures. Injuries such as ecchymosis; hematomas; abrasions; tongue, facial, and limb lacerations; and even shoulder dislocation can develop as a result of the repeated tonic-clonic movements. Atonic seizures are also frequently associated with facial injuries, as well as injuries to the neck. Worldwide, burns are the most common serious injury associated with epileptic seizures. SUDEP Regarding mortality, seizures cause death in a small proportion of individuals. Most deaths are accidental and result from impaired consciousness. However, sudden, unexpected death in epilepsy (SUDEP) is a risk in persons with epilepsy, and it may occur even when patients are resting in a protected environment (ie, in a bed with rail guards or in the hospital). The incidence of SUDEP is low, about 2.3 times higher than the incidence of sudden death in the general population. The increased risk of death is seen mostly in people with long-standing focal-onset epilepsy, but it is also present in individuals with primary generalized epilepsy. The risk of SUDEP increases in the setting of uncontrolled seizures and in people with poor medication compliance. The risk increases further in people with uncontrolled secondary generalized tonic-clonic seizures. The mechanism of death in SUDEP is controversial, but suggestions include cardiac arrhythmias, neurogenic pulmonary edema, and suffocation during an epileptic seizure with impairment of consciousness. Treatment with anticonvulsants decreases the likelihood of an accidental seizure-related death, and successful epilepsy surgery decreases the risk of SUDEP to that of the general population. In 2011, the National Institutes of Health (NIH) convened a workshop on SUDEP to focus research efforts and to determine benchmarks for further study
Posted on: Fri, 22 Aug 2014 07:20:52 +0000
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