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Who burned and how to prevent?
burns 33 (2007) 127–128
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Who burned and how to prevent? Identification of risk for and prevention of burns among epileptic patients Burn is one of the most disabling injuries, with burn sequelae including morphological changes and psychological and functional impairment. There are many reports of burns related to epilepsy [1–7], of which the most common risk factors as seizure frequency and severity and female gender [2–4]. These reports suggest several methods of avoiding burns, such as using microwave ovens rather than gas stoves [4], not showering in a shower cubicle [1], and avoiding risk factors [2]. However, these recommendations are often not practical for an epileptic patient. Furthermore, while from an empirical standpoint epileptic patients are a high-risk population prone to severe burn [1], the true risk for epileptic patients recently, all using anti-epilepsy drugs (AEDs) has not been thoroughly investigated and is unknown. We reviewed the medical records of patients who were admitted to the Hangang Sacred Heart Hospital Burn Center between January 2002 and December 2003. Only patients with a history of epilepsy and who had burns that occurred as a result of seizure activity were studied. Patients who had minor injuries and did not require hospitalization were excluded. Four thousand two hundred seventy-nine patients were admitted to our burn center during the study period. Among them, 13 patients (0.3%) had burns attributable to seizure activity. Only two patients were men. Ten patients were burned during cooking, two patients while showering, and one during hair drying. Three patients were taking four AEDs six were taking three AEDs, and two were taking one drug (one patient had no medication and the medication status of another was unknown). Sixteen drug level measurements were taken among seven of the patients. Only one drug level among these 16 was in the therapeutic range (valproic acid, 50.8 ug/dl). Three patients had willfully discontinued their medication, and one patient was tapering down the level of medication. Currently, avoidance of risk is the primary method for preventing burn injury among epileptics. Spitz et al. [2] identified the total number of seizures, inter-ictal neurological state, and gender as risk factors for burn, and recommended avoiding cooking and showers. Buck et al. [3] similarly found
seizure severity, seizure frequency, and gender to be key predictors. Although the use of multiple AEDs does not necessarily indicate poor seizure control, our results were also similar. All patients we screened were burned during daily activity at home rather than on the job. In part, this is likely due to epileptic patients rarely working in environments that involve fire or hot surfaces. The preponderance of women among our burn patients might well be attributable to their much greater frequency of cooking. Unlike with choices regarding driving or job selection, our patients – especially women – can hardly choose to live without cooking or showering. Epileptic mothers are extremely unlikely to give up cooking with an oven in favor of a microwave, or to forego hot showers for relaxing a tired body. Seizure frequency and severity are accepted as risk factors for burn but have the appearance of being difficult to manage. In our study, only one patient’s seizures were well-controlled, and even she was tapering her doses. Three patients had stopped taking medication altogether, against doctor’s advice. Nine patients were taking three or four AEDs, yet almost all drug levels were sub-therapeutic. In view of this significant finding, we suggest that seizure frequency and severity can be nearly eliminated as risk factors for burn simply by establishing solid encouragement of patients through regular visits to the doctor’s office. We further propose that faithfully taking medication may prevent most burns, and that these will be very infrequent in patients with well-controlled epilepsy. In our study, 0.3% of admissions due to burn were seizurerelated. This proportion is greater than for fatal crash rates involving epileptic drivers (0.2%) [7], although only some of these incidents are caused by epileptic seizures. Data are not available for the prevalence of epilepsy in burn patients. However, seizure-caused auto crashes account for 11% of all auto crashes involving epileptic patients [8], and assuming a similar proportion for seizure-related injuries among burn injuries the prevalence of epilepsy among burn patients could be up to 3%. This is significantly greater than the known general prevalence of epilepsy (0.68%) [6]. However, as mentioned above, most epileptic burn patients were poorly
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burns 33 (2007) 127–128
compliant, so we can say that poorly compliant epileptic patients are a high-risk population prone to severe burns. Epileptic patients especially poorly controlled are more prone to burns than are the general population, but most burns among epileptic patients can be prevented merely by education and encouragement through regular medication and drug level checks. Burn should not be a significant fear for well-controlled epileptic patients.
[5] Karacaogˆlan N, Uysal A. Deep burns following epileptic seizures. Burns 1995;21:546–9. [6] Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester. Minnesota Mayo Clin Proc 1996;71:575–86. [7] Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy driving fatalities vs. other cause of death in patients with epilepsy. Neurology 2004;63:1002–7. [8] Krumholz A, Fisher RS, Lesser RP. Driving and epilepsy. A review and reappraisal. JAMA 1991;265:622–6.
references
[1] Unglaub F, Woodruff S, Deimer E, Pallua N. Patients with epilepsy: a high-risk population prone to severe burns as a consequence of seizures while showering. J Burn Care Rehabil 2005;26:526–8. [2] Spitz MC, Towbin JA, Shantz D, Adler LE. Risk factors for burns as a consequence of seizures in persons with epilepsy. Epilepsia 1994;35:764–7. [3] Buck D, Baker GA, Smith DF, Chadwick DW. Patients’ experience of injury as a result of epilepsy. Epilepsia 1997;38:439–44. [4] Josty IC, Narayanan V, Dickson WA. Burns in patients with epilepsy: changes in epidemiology and implications for burn treatment and prevention. Epilepsia 2000;41:453–6.
Yang-Ki Minn* Department of Neurology, Burn Center, Hangang Sacred Heart Hospital, Hallym University, 94-200 Yeungdeungpo-dong, Yeungdeungpo-gu, Seoul 150-719, South Korea *Tel.: +82 2 2639 5690; fax: +82 2 2635 5827 E-mail address: [email protected] 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.04.021
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Who burned and how to prevent? Identification of risk for and prevention of burns among epileptic patients Burn is one of the most disabling injuries, with burn sequelae including morphological changes and psychological and functional impairment. There are many reports of burns related to epilepsy [1–7], of which the most common risk factors as seizure frequency and severity and female gender [2–4]. These reports suggest several methods of avoiding burns, such as using microwave ovens rather than gas stoves [4], not showering in a shower cubicle [1], and avoiding risk factors [2]. However, these recommendations are often not practical for an epileptic patient. Furthermore, while from an empirical standpoint epileptic patients are a high-risk population prone to severe burn [1], the true risk for epileptic patients recently, all using anti-epilepsy drugs (AEDs) has not been thoroughly investigated and is unknown. We reviewed the medical records of patients who were admitted to the Hangang Sacred Heart Hospital Burn Center between January 2002 and December 2003. Only patients with a history of epilepsy and who had burns that occurred as a result of seizure activity were studied. Patients who had minor injuries and did not require hospitalization were excluded. Four thousand two hundred seventy-nine patients were admitted to our burn center during the study period. Among them, 13 patients (0.3%) had burns attributable to seizure activity. Only two patients were men. Ten patients were burned during cooking, two patients while showering, and one during hair drying. Three patients were taking four AEDs six were taking three AEDs, and two were taking one drug (one patient had no medication and the medication status of another was unknown). Sixteen drug level measurements were taken among seven of the patients. Only one drug level among these 16 was in the therapeutic range (valproic acid, 50.8 ug/dl). Three patients had willfully discontinued their medication, and one patient was tapering down the level of medication. Currently, avoidance of risk is the primary method for preventing burn injury among epileptics. Spitz et al. [2] identified the total number of seizures, inter-ictal neurological state, and gender as risk factors for burn, and recommended avoiding cooking and showers. Buck et al. [3] similarly found
seizure severity, seizure frequency, and gender to be key predictors. Although the use of multiple AEDs does not necessarily indicate poor seizure control, our results were also similar. All patients we screened were burned during daily activity at home rather than on the job. In part, this is likely due to epileptic patients rarely working in environments that involve fire or hot surfaces. The preponderance of women among our burn patients might well be attributable to their much greater frequency of cooking. Unlike with choices regarding driving or job selection, our patients – especially women – can hardly choose to live without cooking or showering. Epileptic mothers are extremely unlikely to give up cooking with an oven in favor of a microwave, or to forego hot showers for relaxing a tired body. Seizure frequency and severity are accepted as risk factors for burn but have the appearance of being difficult to manage. In our study, only one patient’s seizures were well-controlled, and even she was tapering her doses. Three patients had stopped taking medication altogether, against doctor’s advice. Nine patients were taking three or four AEDs, yet almost all drug levels were sub-therapeutic. In view of this significant finding, we suggest that seizure frequency and severity can be nearly eliminated as risk factors for burn simply by establishing solid encouragement of patients through regular visits to the doctor’s office. We further propose that faithfully taking medication may prevent most burns, and that these will be very infrequent in patients with well-controlled epilepsy. In our study, 0.3% of admissions due to burn were seizurerelated. This proportion is greater than for fatal crash rates involving epileptic drivers (0.2%) [7], although only some of these incidents are caused by epileptic seizures. Data are not available for the prevalence of epilepsy in burn patients. However, seizure-caused auto crashes account for 11% of all auto crashes involving epileptic patients [8], and assuming a similar proportion for seizure-related injuries among burn injuries the prevalence of epilepsy among burn patients could be up to 3%. This is significantly greater than the known general prevalence of epilepsy (0.68%) [6]. However, as mentioned above, most epileptic burn patients were poorly
128
burns 33 (2007) 127–128
compliant, so we can say that poorly compliant epileptic patients are a high-risk population prone to severe burns. Epileptic patients especially poorly controlled are more prone to burns than are the general population, but most burns among epileptic patients can be prevented merely by education and encouragement through regular medication and drug level checks. Burn should not be a significant fear for well-controlled epileptic patients.
[5] Karacaogˆlan N, Uysal A. Deep burns following epileptic seizures. Burns 1995;21:546–9. [6] Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester. Minnesota Mayo Clin Proc 1996;71:575–86. [7] Sheth SG, Krauss G, Krumholz A, Li G. Mortality in epilepsy driving fatalities vs. other cause of death in patients with epilepsy. Neurology 2004;63:1002–7. [8] Krumholz A, Fisher RS, Lesser RP. Driving and epilepsy. A review and reappraisal. JAMA 1991;265:622–6.
references
[1] Unglaub F, Woodruff S, Deimer E, Pallua N. Patients with epilepsy: a high-risk population prone to severe burns as a consequence of seizures while showering. J Burn Care Rehabil 2005;26:526–8. [2] Spitz MC, Towbin JA, Shantz D, Adler LE. Risk factors for burns as a consequence of seizures in persons with epilepsy. Epilepsia 1994;35:764–7. [3] Buck D, Baker GA, Smith DF, Chadwick DW. Patients’ experience of injury as a result of epilepsy. Epilepsia 1997;38:439–44. [4] Josty IC, Narayanan V, Dickson WA. Burns in patients with epilepsy: changes in epidemiology and implications for burn treatment and prevention. Epilepsia 2000;41:453–6.
Yang-Ki Minn* Department of Neurology, Burn Center, Hangang Sacred Heart Hospital, Hallym University, 94-200 Yeungdeungpo-dong, Yeungdeungpo-gu, Seoul 150-719, South Korea *Tel.: +82 2 2639 5690; fax: +82 2 2635 5827 E-mail address: [email protected] 0305-4179/$30.00 # 2006 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2006.04.021