Abstract Background Seizures can lead to injuries in patients with epilepsy (PWE). This study seeks to determine the 1-year incidence, types, and associated factors of seizure-related injuries in PWE compared with that of patients without epilepsy. Methods A retrospective cohort study was carried out at the Douala General Hospital, Douala, Cameroon. Patients with active epilepsy within the past 5 years were compared to patients without epilepsy after matching them by age and gender during a 12-month period. Data was collected from patient records using a questionnaire and analyzed using the SPSS version 20 software. The chi-square test was used to compare the proportions of injuries at a significant level of p < 0.05 and a confidence interval (CI) of 95%. Results A total of 155 participants were recruited in each group. Note that 51.6% were males, and the mean age was 25.46 ± 16.35 years. The 1-year incidence of all injuries was 26.5% in PWE against 16.8% among patients without epilepsy, respectively (p = 0.038; odds ratio = 1.8, 95% CI: 1.03–3.10). Soft tissue injury was higher in PWE (82.9%, p < 0.05) compared to those without epilepsy (50%), whereas patients without epilepsy had more cases of burns compared to PWE (p < 0.05). PWE and having frequent seizures with falls and those on more than one antiseizure medication had an increased risk of injuries (p < 0.05). Conclusion PWE have a double risk of having mild soft tissue injuries attributed to epileptic seizures. The risk is increased in PWE having seizures with falls and those taking more than one antiseizure medication.