From the Guidelines
Managing frequent falls in a patient with seizures requires a multifaceted approach that includes optimizing anti-seizure medication, environmental modifications, and physical activity interventions, with a focus on fall prevention and seizure control. The most recent and highest quality study, 1, suggests that physical activity interventions, such as home-based exercises, group exercise programs, strength and balance exercises, and Tai Chi, can significantly reduce the incidence of falls in individuals with mild to moderate vascular cognitive impairment.
Key components of a comprehensive management plan include:
- Optimizing anti-seizure medication therapy to reduce seizure frequency and severity
- Environmental modifications, such as removing tripping hazards, installing grab bars, and ensuring adequate lighting, to minimize fall risk
- Physical activity interventions, as mentioned earlier, to improve balance, strength, and coordination
- Use of safety items, such as grab rails, sensor night lights, and tele-assistance support centers, to reduce the number of falls
- Patient education on seizure safety techniques, including recognizing auras and assuming safe positions during seizures
It is also essential to consider the patient's individual needs and circumstances, such as the presence of any underlying medical conditions or cognitive impairments, when developing a management plan. Regular neurological follow-ups are necessary to adjust treatment plans based on seizure frequency and patterns, and to monitor the effectiveness of the management plan in reducing fall risk and improving the patient's quality of life.
From the Research
Management of Frequent Falls in Patients with Seizures
- The management of frequent falls in patients with seizures requires a comprehensive approach, including optimizing seizure control and implementing fall prevention strategies 2.
- Optimizing seizure control involves distinguishing between provoked and unprovoked seizures and focusing on key elements of the patient's history 3.
- The choice of antiepileptic medication can also impact seizure control, with some studies suggesting that certain medications such as lamotrigine and levetiracetam may be more effective in certain patient populations 4, 5.
- Fall prevention strategies, such as patient education, hourly nurse rounding, nocturnal bed alarms, and the use of ceiling lift systems, can also be effective in reducing the frequency of falls 2.
- Additionally, identifying and addressing potential factors that may lead to breakthrough seizures, such as imperfect adherence, unanticipated changes in ongoing medical therapy, and seizure precipitants, can also play a role in managing frequent falls in patients with seizures 6.
- Some specific interventions that have been shown to be effective in reducing falls in the epilepsy monitoring unit include:
- Increased patient education
- Hourly nurse rounding
- Nocturnal bed alarms
- Having two persons assisting for high fall risk patients when out of bed
- Immediate postfall team review
- Use of ceiling lift systems extending into the bathroom 2