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Burns and epilepsy--review and case report
Alfredo Gragnani1, Bruno Rafael Müller2, Andrea Fernandes Oliveira3
1Plastic Surgery Division of EPM/UNIFESP, São Paulo, Brazil.
Burns : Journal of the International Society for Burn Injuries
|December 3, 2014
Summary
Burn injuries can trigger epilepsy decompensation due to altered drug metabolism and systemic inflammation. This case highlights the need for careful anticonvulsant monitoring in burned patients to prevent recurrent seizures.
Area of Science:
- Medical Science
- Pharmacology
- Critical Care Medicine
Background:
- Epilepsy management can be complicated by systemic conditions like burn injuries.
- Burn injuries trigger a systemic inflammatory response syndrome (SIRS) with distinct physiological phases.
- Altered pharmacokinetics of anticonvulsant medications are a known complication in burned patients.
Observation:
- A 36-year-old epileptic woman experienced recurrent seizures post-thermal injury.
- The patient maintained the same anticonvulsant medications and dosages used for 12 years with prior seizure control.
- Burn-induced physiological changes, including reduced plasma proteins and altered drug clearance, were suspected.
Findings:
- Reduced albumin levels increased the free fraction of phenytoin, leading to higher clearance and lower total drug concentrations.
- Metabolic shifts associated with burns predisposed the patient to breakthrough seizures.
- The patient's epilepsy decompensated despite consistent medication regimen.
Implications:
- Burn-induced physiological changes significantly impact anticonvulsant drug efficacy.
- Close pharmacokinetic monitoring of anticonvulsants is crucial in epileptic patients with burn injuries.
- This case underscores the need for individualized treatment adjustments in managing epilepsy during burn recovery.
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