Orthopedic Injuries in the Epilepsy Monitoring Unit: Review of Safety Procedures in Relation to Complications
Samuel Broll1, Vishal Shah2
1The University of Kansas Health System, 2University of Kansas Medical Center
Objective:
Characterize institution-wide orthopedic complications during Epilepsy Monitoring Unit (EMU) admissions and identify risk factors for such injuries.
Background:
Patients with epilepsy are at risk for orthopedic injuries secondary to seizures and falls. Risk factors include association of chronic anti-seizure medication use leading to development of osteopenia and osteoporosis. The most common orthopedic injuries are upper extremity fractures, vertebral fractures or dislocations. Patients undergoing EMU evaluation for characterization of seizures or pre-surgical evaluation of drug-resistant epilepsy expose patients to orthopedic injuries. While EMU admissions are considered safe, the incidence and impact of such injuries suffered in the EMU are not well studied.
Design/Methods:
This retrospective analysis from Jan 2020 to Dec 2023 at the University of Kansas Medical Center reviewed all EMU admissions for any orthopedic or spine consults during admission. These charts were further examined for clinical variables including epilepsy type, pre-EMU orthopedic injuries, any procedural interventions, and delay in management of epilepsy.
Results:
A total of 1104 video EEG (vEEG) and 262 stereotactic EEG (sEEG) admissions were reviewed with 6 patients identified who suffered orthopedic injuries at a rate of 0.4%. 3/6 patients had isolated shoulder dislocations, 2/6 had thoracic compression fractures, and 1/6 had several injuries including a shoulder dislocation with clavicular and scapular fractures. 5/6 of this cohort had pre-EMU injuries similar to those they sustained during admission. 3/6 patients had a known history of osteoporosis. Surgical management of epilepsy was delayed in 2/6 patients. 3/6 patients continued to have recurrent shoulder dislocations after discharge.
Conclusions:
Orthopedic injuries in the EMU are infrequent but serious. Risk factors of developing orthopedic injuries include a history of osteoporosis and prior orthopedic injuries from seizures, particularly shoulder dislocations and thoracolumbar compression fractures. Orthopedic injuries should not preclude management of epilepsy with patients remaining at high risk for further injuries due to repeat seizures.
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