Head first - Review of epilepsy head injury risk and protection

Introduction: The causes of falls and resultant head injuries in people with epilepsy are complex and represent important clinical issues significantly impacting on safety, quality of life and long-term prognosis. A general solution for many years has been to provide helmets for head protection. There is poor understanding of the influencing risk factors and solutions to give person-centred clinical advice. Methods: A focused narrative review was conducted to investigate the risk factors for seizure-related head injuries and evidence of current helmets to offer protection. Four databases were searched (Embase, Medline, PsycInfo and Cochrane Library) using combinations of text words and thesaurus terms for the retrieval of articles relating to seizure-related head injury. Articles for full analysis were selected by a ten item pre-defined inclusion criteria. Results: Of 104 relevant studies longlisted 21 studies met four or more of the predefined criteria and included in this review. A further nine papers were included because they added additional relevant information. Conclusions: Seizure-related head injury, although rare, may have serious consequences. High doses of anti-epileptic/antiseizure drugs (AEDs/ASDs) and a prescription for three or more AEDs/ASDs are significant, modifiable, risk factors for head injury. Differentiating confusion due to post-ictal changes or concussion can be challenging. Seizure-related cardiac causes leading to injury due to ictal bradycardia or asystole is under investigated. More research is required to validate the protective benefit of various helmet designs in seizure-related head injury. It is striking that there are no International Standards for protective helmets in seizures.