ABSTRACT
PURPOSE: In epileptic patients fractures are six times more frequent than in the general population. Known predisposing factors are anticonvulsant drugs, malnutrition, lack of physical activity and sunlight exposure. METHODS: In this study we describe two patients, one with a bilateral supracondylar fracture and one with a unilateral supracondylar fracture after an epileptic seizure. The literature concerning femur fracture following an epileptic insult is reviewed. RESULTS: A review of the literature revealed several cases of femur fractures associated with epilepsy, however no cases were found involving a supracondylar femur. CONCLUSIONS: Our hypothesis is that a tonic seizure with simultaneous contraction of both agonists and antagonists can cause this type of fracture in predisposing patients.
Subject(s)
Epilepsy/complications , Femur/physiopathology , Fractures, Bone/etiology , Fractures, Bone/physiopathology , Muscle, Skeletal/physiopathology , Adolescent , Anticonvulsants/adverse effects , Cerebral Palsy/complications , Cerebral Palsy/microbiology , Cerebral Palsy/physiopathology , Child , Epilepsy/physiopathology , Femur/diagnostic imaging , Femur/pathology , Fractures, Bone/diagnostic imaging , Humans , Knee/diagnostic imaging , Knee/pathology , Knee/physiopathology , Male , Muscle Contraction , Muscle, Skeletal/innervation , Osteoporosis/complications , Osteoporosis/etiology , Osteoporosis/physiopathology , Radiography , Stress, Mechanical , Syndrome , Vitamin D Deficiency/complications , Vitamin D Deficiency/etiology , Vitamin D Deficiency/physiopathologyABSTRACT
Opisthotonus is a relatively rare, but challenging neurological symptom of spasticity or dystonia that most often results from a dramatic event such as near-drowning. The classic treatment option for opisthotonus is the oral administration of medication such as benzodiazepines and baclofen. However, results with these medications are usually not very beneficial. Numerous studies however have shown that intrathecal treatment with baclofen (ITB) is an efficient and safe treatment for generalized therapy-resistant spasticity, even in children. In this retrospective study, we describe 11 children (mean age 9 years) with pronounced opisthotonus and quadriplegia caused by different types of acquired lesions who were treated with intrathecal baclofen. Results show that in addition to an expected decrease in muscle tonus, there was also a clear improvement in patient comfort and nursing. A remarkable weight gain was observed in most patients, even when calorie intake did not change. This increase in weight might be due to a reduction in energy expenditure as a result of the decrease in spasticity. Intrathecal treatment with baclofen should be considered in every child with opisthotonus.
