The Case for Different Severity of Burns in "Contagious" versus "Possession" Seizures

Serious seizure-related burns are reportedly common in cultures that use ground fire for cooking, heating, or ceremonial purposes. The seriousness of injuries in these cases has been ascribed to the reluctance of bystanders to assist individuals having a seizure either because of fear of contagion (Africa, New Guinea highlands) or because of fear of revenge by the occult (Haiti). We report four Haitian patients who fell into open fires during an epileptic seizure in religious gatherings. Patients were almost immediately rescued from the fire. In contrast to the African and New Guinean patients where upper body involvement was common, burns in these four patients were of moderate severity and involved primarily the lower body. The fear of contagion and belief in magic are interesting notions, but do not explain the different severity and distribution of injuries in these patients. A more likely explanation is that seizures in the African and New Guinean patients occurred while the patient and family were asleep, which probably delayed the rescue, whereas the Haitian patients were helped within moments of falling into the fire in their seizure. The position of the patient at the onset of the seizure is probably what determined the primary areas of thermal injury, and the time to rescue determined their severity and extension.