Brief Communication Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients John C. DeToledo, a, * Merredith R. Lowe, a Jose Gonzalez, b and Helena Haddad c a Department of Neurology, University of Miami, Miami, FL, USA b Epilepsy Foundation Clinic of South Florida, Miami, FL, USA c Fairview Training Center, Salem, OR, USA Received 3 February 2004; revised 25 March 2004; accepted 26 March 2004 Available online 27 April 2004 Abstract We reviewed the incidence of aspiration pneumonia secondary to seizures in three populations of patients with chronic epilepsy: 733 outpatients seen in an Epilepsy Foundation clinic; 806 adult patients admitted to two university video telemetry units; and 95 institutionalized, profoundly retarded adult patients with chronic epilepsy. Two of the 733 adults who had seizures in the outpatient setting and 2 of the 806 patients who had one or more epileptic seizures in the telemetry units developed aspiration pneumonia. In the 95 institutionalized patients, there were 17 instances of aspiration pneumonia after a generalized seizure and 32 instances of aspiration unrelated to seizures over a 12-month period. Our findings suggest that aspiration pneumonia is not a common com- plication of seizures in otherwise healthy adults. The increased incidence of aspiration in developmentally delayed individuals seems to derive from a combination of factors. Increased oral secretions, impaired swallowing mechanisms, and difficulty in attaining adequate patient positioning significantly increased the risk of aspiration. Ó 2004 Elsevier Inc. All rights reserved. Keywords: Seizures; Epilepsy; Convulsions; Aspiration; Pneumonia; Lateral decubitus 1. Introduction Pneumonia is considered to be a common compli- cation of generalized tonic–clonic seizures (GTCS) and is caused by the aspiration of secretions as airway protective reflexes are inhibited by the seizure. Aspi- ration pneumonia is more likely to occur in individ- uals kept supine during postictal recovery [1], hence the recommendation to place the patient in a lateral decubitus to facilitate the drainage of secretions [2]. Whereas this potential complication of seizures has been recognized for almost 40 years, its incidence and risk factors have never been studied in groups of pa- tients with epilepsy. 2. Materials and methods We reviewed the incidence of aspiration pneumonia secondary to seizures in three populations of adult pa- tients with chronic epilepsy: 1. The database of the Epilepsy Foundation Clinic of South Florida for patients with epilepsy treated for pneumonia between May 1999 and May 2000. Cases of status epilepticus were not included, as patients were often taken to nearby hospitals rather than Jackson Memorial Hospital and records were not al- ways available in those cases. 2. PatientÕs history, and telemetry reports of two univer- sity inpatient telemetry units (University of Miami and George Washington University) between the years of 1996 and May 2000. 3. Aspiration pneumonias occurring over 12 months in a cohort of 95 developmentally delayed adult patients with multiple handicaps (DDMH) and chronic epi- lepsy living in an institution [3]. * Corresponding author. Fax: 1-305-243-7668. E-mail address: jdetoled@med.miami.edu (J.C. DeToledo). 1525-5050/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2004.03.009 Epilepsy & Behavior 5 (2004) 593–595 Epilepsy & Behavior www.elsevier.com/locate/yebeh