Purpose
Treating seizure-related shoulder injuries is challenging and an evidence-based consensus to guide clinicians is lacking. The aim of this monocentric prospective observational clinical trial was to evaluate patients’ satisfaction and clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries and to categorize them according to the lesions characteristics and the chosen treatment, with special focus on patients suffering combined fracture-dislocations.
Methods
Patients referred to a tertiary epilepsy centre suffering from seizure-related shoulder injuries and with a minimum follow-up of one year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient reported outcome measure (quick Disabilities of the Arm, Shoulder and Hand questionnaire, qDASH) and a pain assessment tool (Visual Analogue Scale, VAS) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented.
Results
Sixty-four patients were included. After a median follow-up of 4.9 years, the mean EQ-5D-5L index value was 0.76 ± 0.22. Mean qDASH was 32.81 ± 24.64 points, with 27.4% of the patients scoring < 15 points (no problems), and 35.5% of the patients > 40 points (severe disability); mean VAS was 23.38 ± 37.20 mm, with 30.0% of the patients scoring > 35 mm (moderate to severe pain). 40.6 % of the patients considered themselves unsatisfied with the treatment due to persistent pain, compromised upper limb function or as a consequence of the complications. Persistent fear of a new shoulder injury was reported in 63.5% of the patients.
Conclusions
Patients suffering from seizure-related shoulder injuries report only moderate clinical results at mid-term follow-up; these results are inferior to those reported in high-quality trials not restricted to patients with seizures. In a high percentage of cases, residual moderate to severe pain and disability persists after treatment. This warrants special care and appropriate counselling when treating this subgroup of patients.