The Role of Seizure Disorders in Burn Injury and Outcome in Sub-Saharan Africa

Abstract

OBJECTIVE Patients with epilepsy have higher incidence and severity of burn injury. Few studies describe the association between epilepsy and burns in low-income settings, where epilepsy burden is highest. We compared patients with and without seizure disorder in a burn unit in Lilongwe, Malawi. METHODS We conducted a retrospective study of patients admitted to the Kamuzu Central Hospital burn ward from July 2011 to December 2012. Descriptive analysis of patient characteristics and unadjusted and adjusted analyses of risk factors for mortality were conducted for patients with and without seizure disorder. RESULTS Prevalence of seizure disorder was 10.7% in our population. Adults with burns were more likely to have seizure disorder than children. Flame injury was most common in patients with seizure disorder, whereas scalds predominated among patients without seizure disorder. While mortality did not differ between the groups, mean length of stay was longer for patients with seizure disorder, 42.1 days versus 21.6 days. CONCLUSION Seizure disorder continues to be a significant risk factor for burn injury in adults in Malawi. Efforts to mitigate epilepsy will likely lead to significant decreases in burns among adults in sub Saharan Africa and must be included in an overall burn prevention strategy in our environment.

A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region

“…Among studies with adults only, men are found to be more at risk especially between 20 and 30 years of age [100] , [102] , [103] , [105] , [106] . Scald injuries (usually in children) and flame injuries (usually in adults) are the most common types of injuries [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , …”

“…Many burn injuries occur during the cool/dry/windy months [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [68] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [100] . Epilepsy is a common contributing factor to burn injuries [47] , [50] , [62] , [63] , [64] , [65] , [66] , [68] , [74] , [100] , [107] .…”

Burn Injury in Epileptic Patients- A Retrospective-Descriptive Study in a Tertiary Burn Care Unit

“…26 Similarly, our incidence of partial seizure was comparable to standard pattern. Boschini L et al 21 in their study found that patients with epilepsy have higher incidence and severity of burn injuries. Jang YC et al 22 in their study mentioned that in epileptic burns, the most commonly associated seizure type was generalised tonic-clonic followed by absence and complex partial.…”

Ictal analgesia in temporal lobe epilepsy – The mechanism of seizure-related burns

“…The inhibitory network is recruited by the primary somatosensory cortex-orbitofrontal-cingular-amygdalar network allowing the impact of emotional/cognitive changes [20]. The anti-analgesic effect of PAG-activation has been used in deep brain-stimulation treatment of chronic pain in humans [24][25][26][27][28].…”