{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T02:01:39Z","timestamp":1791684099965,"version":"4.3.4"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T00:00:00Z","timestamp":1556150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>We present a systematic review of the literature regarding types and anatomic distribution of fractures in association with generalized convulsive status epilepticus (GCSE) and convulsive seizures in adult patients accompanied by an illustrative case of a patient with GCSE and diffuse postictal pain from underlying bone fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The library search engines PubMed and EMBASE were screened systematically using predefined search terms. All identified articles written in English were screened for eligibility by two reviewers. The preferred reporting items for systematic reviews and meta\u2010analyses guidelines were followed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The screening of 3145 articles revealed 39 articles meeting the inclusion criteria. Among all fractures, bilateral posterior fracture\u2010dislocations of the shoulders were reported most frequently (33%), followed by thoracic and lumbar vertebral compression fractures (29%), skull and jaw fractures (8%), and bilateral femoral neck fractures (6%). Risk factors for seizure\u2010related fractures are seizure severity, duration of epilepsy, the use of antiseizure drugs known to decrease bone density, and a family history of fractures. Based on these findings, a three\u2010step screening procedure is proposed to uncover fractures in the postictal state. All studies were retrospective without standardized screening methods for seizure\u2010associated fractures resulting in a very low level of evidence and a high risk of bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Posterior fracture\u2010dislocations of the shoulders, thoracic and lumbar vertebral compression, fractures of the skull and jaw, and bilateral femoral neck fractures are most frequently reported. Preventive measures including bone densitometry, calcium\/vitamin D supplementation, and bisphosphonate therapy should be reinforced in epilepsy patients at risk of osteoporosis. As long as the effect of standardized screening of fractures is not investigated, it is too early to integrate such a screening into treatment guidelines. In the meantime, clinicians are urged to heighten awareness regarding seizure\u2010associated fractures, especially in patients with postictal pain, as symptoms can be unspecific and misinterpretation may impede rehabilitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.14738","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T14:28:26Z","timestamp":1556202506000},"page":"996-1004","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Bone fractures from generalized convulsive seizures and status epilepticus\u2014A systematic review"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6723-320X","authenticated-orcid":false,"given":"Pascale","family":"Grzonka","sequence":"first","affiliation":[{"name":"Medical Intensive Care Units University Hospital Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Rybitschka","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Units University Hospital Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"De Marchis","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Basel Basel Switzerland"},{"name":"Medical Faculty University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Marsch","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Units University Hospital Basel Basel Switzerland"},{"name":"Medical Faculty University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6575-356X","authenticated-orcid":false,"given":"Raoul","family":"Sutter","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Units University Hospital Basel Basel Switzerland"},{"name":"Department of Neurology University Hospital Basel Basel Switzerland"},{"name":"Medical Faculty University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002843"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597-16.1.48"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.07.017"},{"key":"e_1_2_10_5_1","first-page":"224","article-title":"Bilateral shoulder dislocation in a 32\u00a0years old male because of generalised tonic clonic status epilepticus","volume":"43","author":"Chand K","year":"1995","journal-title":"Neurol India"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(85)80453-4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/omcr\/omw055"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-3206-3"},{"key":"e_1_2_10_9_1","first-page":"120","article-title":"The importance of imaging for status epilepticus patients to rule out fractures \u2010 A case report","volume":"8","author":"Alenazi BR","year":"2013","journal-title":"J Taibah Univ Med Sci"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197007162830307"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197153070-00023"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1973.tb03967.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(74)90169-7"},{"key":"e_1_2_10_14_1","first-page":"1267","article-title":"Arthrokatadysis of hip following convulsive seizure","volume":"75","author":"Krishnan SG","year":"1975","journal-title":"N Y State J Med"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.65B2.6826625"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.4.2.115"},{"key":"e_1_2_10_17_1","first-page":"819","article-title":"Simultaneous bilateral fractures of the femoral necks and the proximal humeral heads during convulsion","volume":"17","author":"Liebergall M","year":"1988","journal-title":"Orthop Rev"},{"key":"e_1_2_10_18_1","first-page":"129","article-title":"Fracture\u2010dislocation of the lumbosacral spine during a grand mal epileptic seizure. A case report","volume":"74","author":"Grabe RP","year":"1988","journal-title":"S Afr Med J"},{"key":"e_1_2_10_19_1","first-page":"139","article-title":"Posterior fracture dislocation of the shoulder secondary to epileptic seizures","volume":"36","author":"Silbergeld DL","year":"1991","journal-title":"J R Coll Surg Edinb"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02552123"},{"key":"e_1_2_10_21_1","first-page":"382","article-title":"Bilateral fracture\u2010dislocation of the shoulder following a convulsive seizure. A case report","volume":"97","author":"Marty BS","year":"1994","journal-title":"Unfallchirurg"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199401000-00017"},{"key":"e_1_2_10_23_1","first-page":"249","article-title":"Bilateral posterior four\u2010part fracture\u2010dislocation of the shoulder","volume":"61","author":"Martens C","year":"1995","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199506000-00020"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.6.2.185"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(02)00837-6"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1673.2001.00938.x"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3928\/0147-7447-20020701-17","article-title":"Simultaneous bilateral femoral neck fracture and greater tuberosity shoulder fracture resulting from seizure","volume":"25","author":"Haronian E","year":"2002","journal-title":"Orthopedics"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-006-0066-1"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2006.04.012"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2007.02.012"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20080301-02"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.4103\/0973-6042.57935"},{"key":"e_1_2_10_34_1","first-page":"199","article-title":"Seizure\u2010induced lumbar burst fracture associated with conus medullaris\u2010cauda equina compression","volume":"17","author":"Sharma A","year":"2011","journal-title":"Diagn Interv Radiol"},{"key":"e_1_2_10_35_1","first-page":"240838","article-title":"Literature review and clinical presentation of bilateral acetabular fractures secondary to seizure attacks","volume":"2012","author":"Nehme AH","year":"2012","journal-title":"Case Rep Orthop"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.11138\/jts\/2014.2.3.146"},{"key":"e_1_2_10_37_1","first-page":"1018","article-title":"Neglected Bilateral Posterior Shoulder Fracture Dislocation in an Uncontrolled Seizure patient","volume":"31","author":"Amir MA","year":"2015","journal-title":"Pak J Med Sci"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcr.2017.11.006"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.39.6.858"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1997.tb01733.x"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.4065\/84.6.495"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02782.x"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.02.004"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.091027"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2012.10.002"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1999.tb00675.x"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1976.tb04794.x"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000076"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2005.23804.x"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(95)00189-1"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00433931"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1053\/seiz.1999.0301"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.14738","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/epi.14738","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.14738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T01:30:38Z","timestamp":1694050238000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.14738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,25]]},"references-count":51,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1111\/epi.14738"],"URL":"https:\/\/doi.org\/10.1111\/epi.14738","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,25]]},"assertion":[{"value":"2018-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}