this is particularly true for subgroups of patients with symptomatic epilepsy , frequent generalized tonic fortunately , the injuries are most often trivial , with abrasions , contusions , and wounds being the most frequent . however , more severe injuries may also occur , like burns , head or dental injuries , and fractures . studies have shown an increased risk of fractures among people with epilepsy , but the extent of the increase is debatable . most fractures are caused by falls , but nontraumatic fractures caused by the seizures themselves have also been reported . although seizure - related compression fractures of the vertebral corpora in the thoracic spine are fairly well known , these complications are easily overlooked as some may be subclinical . generalized tonic clonic seizures comprise are the seizure type that is most often associated with such fractures , and the seizures may not always be due to epilepsy . here , i present a patient with symptomatic focal epilepsy who sustained a femoral neck fracture following a long - lasting focal motor seizure . the patient is a 47-year - old man living in a nursing home for people with epilepsy and disabling comorbidities of neurological , cognitive , and/or psychiatric nature . he has a long history of drug abuse ; for many years , he was addicted to amphetamine . at the age of 37 , he had a subarachnoidal hemorrhage ( sah ) which caused a left - sided hemiparesis and mild cognitive deficiency . eventually , he was able to walk with some assistance , but he spends most of his time in a wheelchair . in the first two years following the sah , he had two epileptic seizures . the first was a short - lasting focal motor seizure with left - sided convulsions and preserved consciousness . clonic seizure starting with left - sided jerks . following the last seizure , he was given lamotrigine , and on this medication while sitting in a wheelchair and possibly precipitated by an upper respiratory infection , he had a focal motor seizure with left - sided convulsions . during the seizure even though 25-mg ( 10  +  15-mg ) diazepam was given rectally , the seizure lasted more than 2  h. thus , he was transported to the local hospital . here , the seizure activity stopped spontaneously . on the following days , he complained of pain in the left hip area , and on the third postictal day , an x - ray of the hip disclosed a medial fracture of the left femoral neck ( fig . three months after this event , he had an assessment of bone mineral density in the right femur and lumbar spine ( dxa ) . the values were 2.0 and 1.7 sd below mean , respectively ( t - score :   2.3 and   2.0 ) . this case illustrates that forceful contractions sufficient to cause fractures may not only be associated with generalized tonic  clonic seizures . this case illustrates that focal motor convulsions may give rise to such severe seizure - related complications . predisposing factors in this case were the long duration of the convulsions , i.e. , the seizure developed into epilepsia partialis continua , and his low bone mineral density . whether his sitting position ( he was sitting in a wheelchair during the first half hour of the seizure before he was lifted into a bed ) may have also played a role is uncertain . if and to what extent antiepileptic drugs are responsible for the decreased bone mineral density and increased fracture rate seen in people with epilepsy have been a matter of much debate for the last few years . while the enzyme - inducing drugs are assumed to exert a negative effect on bone health , drugs like lamotrigine , which was used in this case , however , bone strength is influenced by several factors other than drugs , e.g. , inheritance , smoking and exercise habits , bmi , nutrition , sun exposure , and some diseases . in this case , physical inactivity and heavy smoking is assumed to have contributed to the low bone mineral density and thus an increased susceptibility to fractures . in all patients who , in the postictal phase of an epileptic seizure , focal or generalized , present with severe pain in the hip area and inability to walk , a fracture of the femoral neck should be suspected . to avoid avascular necrosis of the femoral head ,
people with epilepsy are more accident prone than the non - epilepsy population . 
 bone fractures are most often due to seizure - related falls 
 . however , seizures themselves , in particular generalized tonic - clonic seizures , may also cause fractures , e.g. of the thoracic spine . here , i present a man who developed focal epilepsy following a subarachnoidal hemorrhage . during a focal motor seizure with left - sided convulsions and preserved consciousness that lasted 2 hrs , he sustained a femoral neck fracture . in persons with low mineral density , as in this case , contractions associated with simple focal motor seizures may be sufficient to give rise to such a severe complication .