Epilepsy and burns: Description of case

ABSTRACT

Epilepsy is one of the most common neurological disorders worldwide, affecting more than 70 million people worldwide; on the other hand, burns are traumatic events that represent an important public health problem. Considering the relationship that has been documented between epilepsy and burns, a descriptive cross-sectional study was carried out in the burn unit of a tertiary care hospital in the city of Bogotá, Colombia. 78 medical records were reviewed, 20 correspond to patients burned during a convulsive episode, most of the cases occurred in single women (65%) with an average age of 44 years, mostly from urban areas (70%), with main occupation housewife (45%), the main trigger of the epileptic crisis was poor adherence to treatment (70%), 95% of the patients did not have a previous control by neurology and the body area most affected was the upper limbs (arms) in 55%, the average hospital stay was 20 days in the Intensive Care Unit. Epilepsy is a disease with poor adherence to medication and inadequate neurological follow-up that may be related to the presence of convulsive episodes, which can lead to serious problems such as burns, with the consequent impact on the quality of life of patients. as well as important consequences that make it impossible for the person to return to work, becoming a public health problem.

Keywords: Epilepsy, burns, Colombia.

INTRODUCTION

Epilepsy is a chronic disease of the central nervous system (CNS) that affects more than 70-80 million people worldwide affect and is the fifth most frequent neurological disease, defined as two unprovoked seizures occurring more than 24 hours apart or a single seizure with a high risk of recurrence. These seizures occur as a result of an imbalance in excitatory and inhibitory activity within a neural network such that it will perform excessive, hypersynchronous, and oscillatory function that, when sustained, disrupts standard neural processing(1,2,3).

This disease is a significant cause of disability and premature mortality, increasing the burden on health care resources, especially in low-income countries. According to a study carried out in 2015, epilepsy was responsible for 0.88% of deaths in Colombia, including people who died of status epilepticus and those who died with injuries due to this disease; the most significant number of patients treated with a diagnosis of epilepsy in Bogotá(4).

The number of convulsive episodes and the type of crisis relates to increased risk situations for epileptic patients. Among these, we can find burns since there is a high recurrence of convulsive events during activities of daily living, which can become potentially dangerous. The severity of the injuries associated with seizure episodes relates to the poor reaction that the patient has during the seizure episode and the tissue injury. Additionally, these burns may require surgical interventions, increased risk of complications, prolonged hospital stay, need for intensive care units, and even a fatal outcome(5,6).

In Colombia, the Incidence is 1.8% and is close to world reports that suggest an incidence of 3 to 10% of admissions to Burn Units and 3.7 to 15.9% of epileptic adults have suffered a burn due to a convulsive status(7). The increased Incidence of burns in this population is the frequency of the seizure attack, as it occurs without any warning signs, the duration of the episode, and the lack of awareness and education about the risk of burns among epileptic patients(8).

Indirect costs, such as lost wages, prolonged care for deformities and emotional trauma, as well as the use of family resources, also contribute to the impact. In a cost study carried out by the Hospital Simón Bolívar (Bogotá, Colombia) for the period from January to June 2015, the total operating cost of the burn unit was US$2,890. 043 dollars) which shows the critical impact of this pathology on the economy of the health system(9).

For this reason, burn injuries related to epilepsy represent a public health problem, most patients, especially low-income populations, do not know the implications that can occur with this type of accident, and those health professionals fail to identify promptly the factors related to this problem due to the scarce literature.

MATERIALS AND METHODS

A descriptive cross-sectional study in which data from the medical records of patients treated at a third-level health care hospital in Bogotá, a reference center in Colombia. For analysis, patients who suffered burns secondary to convulsive events between August 2019 and December 2020. The data extracts from the medical records using tools and a database created in Excel under the appropriate management of data protection. Descriptive analysis of all variables. The quantitative variables’ mean, standard deviations, and interquartile ranges measure frequency. For qualitative variables, frequencies are in percentages-no analysis of comparison or association between variables.

RESULTS

We reviewed 78 medical records of burned patients admitted to the Burn Unit of a tertiary care hospital in Bogotá; 20 were patients burned during a convulsive episode, and the remaining 56 were discarded because they did not. They had a history of epilepsy. Of the cases found, the mean age was 44 years, and a notable gender difference; female patients (65%) compared to male patients (35%) single in 85%, having a higher frequency of presentation in urban areas (70%); mainly the occupation was the home (45%), unknown (25.5%). Table I

At the time of the evaluation, 95.0% of all the patients did not have a previous control by Neurology, and only 55% knew their diagnosis of epilepsy. Among the primary triggers of epileptic seizures poor adherence to pharmacological treatment (7%), she follows by unknown etiology (20%). Contact with hot water was the primary burn mechanism (70%), followed by boiling oil (15%).

The most common type of seizure associated with burns was generalized (40%), followed by focal seizures (35%). It observes that the most affected body area was the upper extremities (arms) in 55%, followed by the chest region (22%), and the most frequent degree of the burn was degree II (55%). Graph I

All patients required hospitalization in the Intensive Care Unit with an average hospital stay of 20 days, and only two patients did not require surgery. Likewise, cranial tomography in 80% of the patients and video telemetry in 15%; however, despite prolonged hospitalization and compromised compromise, all patients survived.

DISCUSSION

Epilepsy and burns have a high incidence worldwide, especially in low-income countries; they have a high correlation because seizures are an important predisposing factor. In Colombia, there are not enough studies demonstrating the association of burns with convulsive events despite their frequency and the significant impact on public health since they represent high costs for the health system, prolonged incapacities, disability, and physical, psychological, and occupational consequences.

This study found that the majority of cases occurred in single women (65%) with an average age of 44 years, mostly from urban areas (70%), with occupation as housewives (45%); in national studies, it has that the highest Incidence is in single women who are housewives between the ages of 43 years(10).

Studies have concluded that seizures are an important predisposing factor in burns and affect essential areas, and develop mainly during the performance of domestic tasks or personal actions(11). On the other hand, research reports that the most frequent mechanism is fire, flames, or hot liquid; as observed in our study, contact with hot water was the primary burn mechanism (70%), followed by boiling oil (15%). It evidences that the most affected body area was the upper extremities (arms) in 55%, followed by the chest region (22.0%). Consistent with a report of 3 cases carried out in Romania, the most frequently injured areas were the facial region and upper extremities, followed by injuries to the trunk(12), with grade II being the most frequent (55%) in our study.

As this study showed, the main trigger for epileptic seizures was poor adherence to treatment, representing 70%. Up to 53% of patients do not use antiepileptic drugs as prescribed by their treating physician, which not only contributes to difficult seizure control, leads to higher rates of seizure recurrence, but also increases health care costs by increasing visits to the emergency room(13). Likewise, it is noteworthy that 95% of the cases did not have previous control by neurology, which shows the clinical challenge that we currently face and how to optimize the adherence and medical follow-up of these patients; this represents tremendous importance for our population since epileptic patients have a high risk of morbidity and mortality, disability, and accidents, which translates into an increase in the costs of both care and public health, due to the lost years of useful life derived from disability secondary to a burn.

As has been reported in the literature, epileptic burn patients expect in Colombian Burn Units, even though clinical and epidemiological data on this patient population remain scarce in our setting(8). The most important risk factors for the increased incidence of burns in epileptic patients are the frequency of the seizure attack as it occurs without any warning signs, leading to loss of consciousness, duration of the episode, lack of consciousness, and education about the risk of burns among epileptic patients(14).

This research agrees with reports in the literature by showing that burns continue to be an essential factor of severity in epileptic patients, related to ignorance of the disease, poor adherence to treatment, management in sub-therapeutic doses, and lack of treatment of follow-up by neurology; this leads to prolonged hospitalizations in the intensive care unit, representing a threat to the same patient, affecting the quality of life and work since most patients are of productive age.

CONCLUSION

Epilepsy is a prevalent disease; low adherence to medication and inadequate neurological follow-up may relate to convulsive episodes, which can lead to severe problems such as burns, with the consequent affectation on patients’ quality of life. Prolonged patients and ICU stays, as well as significant sequelae that make it impossible for the person to return to work, become a public health problem. For this reason, it is of great importance to develop plans to contribute to the prevention of these cases by carrying out activities that educate both doctors and patients about the dangers and thus reduce the development of secondary disability. It is necessary to carry out studies with samples of older patients that allow us to obtain more significant results.

REFERENCES