Case Reports

Mystery Burns and Nocturnal Seizure Safety

Author and Disclosure Information

Thermal burn injuries are common and are associated with physical and psychologic repercussions. For epileptic patients, the risk for environmental injuries is remarkably higher. We present 2 cases of thermal burn injuries following nocturnal seizures. Many epileptic patients are educated on ways to prevent injury; however, these safety precautions tend to focus primarily on daytime activities. We highlight the potential presentation and impacts of the thermal lesions. In addition, we offer suggestions for improvements in patient education and injury prevention.

Practice Points

  • Burns and scars from burns can lead to both life-threatening consequences and lifelong psychological effects.
  • Many epileptic patients who present with thermal burn injuries do not remember getting burned.
  • Clinicians should be aware of all the potential dangers that patients with epilepsy may encounter both during the day and night.


 

References

Patients with seizures are placed at an increased risk for sustaining burn injuries, which may occur during common daily activities such as cooking, showering, and using heaters.1 Although patients are warned of the risks of injury at the time of their epilepsy diagnosis, patients still experience injuries that commonly occur during the seizure or the postictal phase. In a study of 134 patients with epilepsy, only 38% recalled being burned during a seizure, with approximately 9% being burned multiple times.2 Another study investigated the circumstances resulting in burns in this patient population and found that cooking on a stove was the most common cause, followed by hot water while showering and exposed room heaters.1 Another study found that the majority of burns in seizure patients were from spilled hot drinks.3

We report 2 patients who presented to the dermatology clinic with second-degree burns following nocturnal seizures. In both cases, the patients were sleeping next to exposed heaters, which led to burn injuries from seizures that occurred in the night.

Case Reports

Patient 1
A 30-year-old woman with a history of a seizure disorder presented with painful second-degree blistering burns along the left arm and flank (Figure 1). One day prior to presentation, she had woken up to find these lesions and visited the emergency department where she was prescribed silver sulfadiazine cream to prevent infection of the wound site and was referred to our dermatology clinic. Initially, the patient had difficulty pinpointing the source of the burn lesions and thought that it may have been due to sleeping with her cell phone, but she later realized that they were due to the space heater placed next to her bed. Because of the unclear etiology at the initial presentation, a skin biopsy of a lesion was taken while she was at the clinic.

Figure 1. A and B, Blisters from a thermal burn injury (patient 1).

Biopsy of the lesions exhibited separation of the epidermal and dermal layers (Figure 2). Thermal damage was seen extending into the dermal layers with notable edema present. A few inflammatory cells, neutrophils, and monocytes were noted in the biopsy. The initial pathology results showed the epidermis was necrotic with edema, spongiform vesicles, and few neutrophils. The histologic findings aligned with the timeline of the injury occurring 2 days prior to the biopsy. She was treated supportively using mupirocin ointment to prevent secondary infection.

Figure 2. Histology revealed necrosis with minimal inflammation consistent with a thermal burn injury (H&E, original magnification ×100).

Case 2
A 27-year-old woman with a history of epilepsy presented to the dermatology clinic with painful blistering lesions along the right upper arm (Figure 3). She was found to have notable second-degree burns along the right arm. She reported placing her bed near a baseboard heater to stay warm overnight. She noticed the painful lesions after waking up next to the heater following a suspected seizure. She was treated supportively using mupirocin ointment to prevent secondary infection.

Figure 3. A and B, Blisters from a thermal burn injury (patient 2).

Next Article: