'Postignitic epilepsy' (seizures following burns of the skin)

Seizures may occur in patients with burns of the skin and the term 'postignitic epilepsy' is proposed for this condition. In this collaborative study the effects of burns on the CNS have been studied, especially seizures (73 cases) and cognitive or behavior disorders (217 cases). Seizures were usually generalized, at times with a unilateral predominance, more often right sided, appearing in patients usually under the age of 12 yr with the highest incidence in the second year of life. The latency to seizures was highest at 18 to 24 hr after the burn, then linearly fell to the fifth day. Beyond that time the latency varied considerably, but most cases of seizures occurred within 2 mth after the burn. Young infants have attacks usually with a shorter latency than older children. Patients with seizures have a significantly higher percentage of total body surface burned than most patients admitted to a burn unit. The etiology of these seizures is varied, just as in all other forms of epilepsy. The one single factor that seems most significant is hyponatremia, in association with cellular hydration and even cerebral edema. The other etiologies encountered include hypoxia, hemoconcentration, hemodilution, acidosis, hypertension, sepsis, hexachlorophene and previous history of seizure disorder. Patients with sepsis and previous seizures usually were older, with a greater amount of total body surface burned and a longer latency to the seizures than patients with other types of etiology. Patients with cognitive or behavior disorders usually had a greater total body surface burned than most patients entering a burn unit, including those developing seizures. EEGs (49) were done on acutely ill inpatients of a burn unit and also chronic cases (27) with seizures or cognitive behavior disorders who were outpatients. In the acute cases, EEG abnormality (in 88% of patients) seemed related to the combination of total body surface burned and time after burn and was maximal not immediately after the burn, but within 3 to 11 days after the trauma. All chronic cases showed abnormal records and those with seizures had more severely abnormal tracings (including 41% with epileptiform activity) than those with cognitive behavior disorders.