title: Burns and epilepsy--review and case report.
abstract: Decompensation of epilepsy in burned patients may be caused by several factors. Burn is a classic etiology of systemic inflammatory response syndrome, and evolves into two physiological phases. The first 48h after injury corresponds to the first phase involving severe hypovolemic shock. The second phase corresponds to the hypermetabolic response to burns. Altered pharmacokinetics of anticonvulsant drugs is observed. Albumin and other plasma proteins are reduced, leading to increased free fraction of phenytoin, resulting in greater clearance and a lower total drug concentration. Associated with metabolic changes of burned patient, this fact predisposes to seizures in epileptic burned patients. The authors present the case of an epileptic 36-year-old-woman who developed recurrent seizures after a thermal injury, despite using the same medications and doses of anticonvulsant drugs of last 12 years, with controlled epilepsy.
authors.affiliation: Plastic Surgery Division of EPM/UNIFESP, São Paulo, Brazil. Electronic address: alfredogf@ig.com.br.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gragnani
authors.affiliation: EPM/UNIFESP, São Paulo, Brazil.
authors.forename: Bruno Rafael
authors.initials: BR
authors.lastname: Müller
authors.affiliation: Postgraduate Program in Translational Surgery, EPM/UNIFESP, São Paulo, Brazil.
authors.forename: Andrea Fernandes
authors.initials: AF
authors.lastname: Oliveira
authors.affiliation: Plastic Surgery Division of EPM/UNIFESP, São Paulo, Brazil.
authors.forename: Lydia Masako
authors.initials: LM
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000493:pharmacokinetics; D002056:Burns / Q000150:complications* / Q000378:metabolism; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D010672:Phenytoin / Q000493:pharmacokinetics
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin
keywords: Burns; Epilepsy; Hypoalbuminemia; Phenytoin; Seizures