ABSTRACT
BACKGROUND AND PURPOSE: To identify predictors of seizure-related injury (SRI) and death in people with epilepsy (PWE) in a North Indian cohort. METHODS: This ambispective cohort study included PWE registered in an epilepsy clinic in Delhi between May 2010 and December 2011. Five hundred twenty-six patients were enrolled and followed for 25 months. Patients were categorized into two groups based on SRI/no SRI during the study period. We analyzed various factors to identify predictors of SRI and death. RESULTS: Of 526 patients, 355 (67.5%) reported having no SRIs and 171 (32.5%) had sustained an SRI. Among patients with SRI, 72.5% were male; 62% of those with no SRI were male. The injury type included soft tissue (60%), head trauma (20%), dental trauma (10%), orthopedic (10%), and burns (5%). On univariate analysis, factors predicting SRI occurrence were male gender, abnormal birth history (p < 0.01), abnormal mental status (p < 0.01), seizure duration (p < 0.04), daytime seizures (p < 0.05), dependence on a caregiver (p < 0.008), and uncontrolled seizures (p < 0.001), history of cluster seizures or status epilepticus (p < 0.001), occurrence of generalized tonic-clonic seizures (GTCS), and use of >3 antiepileptic drugs (p < 0.008). On multiple logistic regression analysis, male gender, uncontrolled seizures, history of cluster seizures or status epilepticus, and GTCS were significant risk factors. Sixteen deaths occurred in our cohort, and 13 fit the definition of probable sudden unexpected death in epilepsy (SUDEP). Most patients with SUDEP had an unwitnessed event (69.2%). The only significant factor in predicting death was uncontrolled seizures. CONCLUSIONS: Male gender, occurrence of GTCS, uncontrolled seizures, and history of cluster seizures or status epilepticus predicted SRI occurrence in PWE. Precautions should be taken by caregivers of patients with these risk factors, to prevent injury.
ABSTRACT
OBJECTIVES: The study aimed to evaluate the feasibility and yield of semiological features from home videos and compare them to those inferred from history provided by the caregiver of a person with epilepsy (PWE). A comparison of the accuracy of classification of epilepsy based on home videos and medical history was also done. METHODS: We enrolled PWEs who were awaiting admission for video electroencephalography (VEEG) to the epilepsy monitoring unit (EMU) in this prospective observational study. In phase I of the study, we encouraged caregivers to make home videos which were analyzed. A structured questionnaire dealing with 29 different semiological features was completed based on the information gathered from home videos. In phase II of the study, the questionnaire was administered to the patient's caregivers. In phase III the patients underwent VEEG recording, and the semiology from VEEG was analyzed to complete the same questionnaire. We also classified epilepsy type using home videos and medical history and compared it to that using VEEG finding. The information gathered from VEEG was considered the gold standard. Accuracy was calculated for the different semiological signs comparing medical history to VEEG findings. RESULTS: A total of 340 PWE fulfilled the inclusion and exclusion criteria, and their caregivers completed the questionnaire. Home videos were collected from 312 patients and 624 seizures were analyzed. The mean number of signs of semiology recorded after analysis of home videos was 3.3±2.2, and from the medical history was 2.1±1.1 (P<0.01). A total of 572 seizures in 282 patients admitted in the EMU were evaluated on VEEG. Bilateral generalized clonic movements of limbs, motor movement around mouth, fear, visual phenomenon, hemisensory phenomenon, and post-ictal unilateral weakness had the highest accuracy. The overall agreement of semiological signs inferred from medical history versus VEEG was 0.75 and between home video recordings versus VEEG was 0.92. A larger number of patients were correctly categorized into the focal epilepsy group when home videos were used to classify compared to when medical history was used. CONCLUSIONS: Home videos are more reliable in picking up semiological signs and classifying epilepsy type than history provided by caregivers of PWEs. Home videos are a complementary tool in a developing country like India.
