Seizure-induced shoulder dislocations – Case series and review of the literature

Abstract

PurposeWe aimed to identify clinical characteristics of patients with shoulder dislocations caused by an epileptic seizure. MethodsIn our retrospective analysis, we identified 15 patients, recorded over an 8-year period, who were diagnosed with shoulder dislocations in the setting of a bilateral tonic-clonic seizure. ResultsPatients were almost exclusively male (13/15) and drug-naïve patients suffering their first or second seizure (14/15). Epilepsy was diagnosed in five of these 14 patients after further diagnostic tests, four patients were diagnosed with a provoked or acute symptomatic seizure and five patients with an unprovoked seizure. Treatment with anticonvulsant drugs (AED) was initiated in 10/15 patients after the first seizure, without recommendation for tapering, although long-term treatment was retrospectively judged to be appropriate for only four of those cases. Posterior dislocations – usually rare – were seen in 12/15 patients and often required complex orthopedic interventions. ConclusionsWe conclude that in particular posterior shoulder dislocations are often caused by a first seizure and should always raise the suspicion of an epileptic seizure even in the absence of a clear history. AED treatment likely has a protective effect against this type of injury, even if seizure-freedom is not achieved.