MEDICAL MANIPULATIONS ON EPILEPTIC PATIENTS
Abstract
Medical manipulations on epileptic patients are associated with risk of occurrence of seizures. However, such risk is often overestimated. In 902 epileptic patients examined, only 3 epileptic seizures were recorded, which have occurred during surgical intervention under general anesthesia. This article presents data on the effects of systemic anesthetics, surgical intervention itself and concomitant medicinal treatment over occurrence of epileptic seizures. The issues of epileptic patients’ preparation for elective surgery are discussed.
About the Author
A. E. Kotov
FUV GU MONIKI named after M.F. Vladimirsky
Russian Federation
Department of Neurology
Russian Federation
Department of Neurology
References
1. Akeson J, Didriksson I. Convulsions on anaesthetic induction with sevoflurane in young children. Acta Anaesthesiol Scand. 2004;48:405–407.
2. Alloul K, Whalley DG, Shutway F, et al. Pharmacokinetic origin of carbamazepineinduced resistance to vecuronium neuromuscular blockade in anesthetized patients. Anesthesiology. 1996;84:330–339.
3. Babb TL, Ferrer-Brechner T, Brechner VL, et al. Limbic neuronal firing rates in man during administration of nitrous oxide-oxygen or sodium thiopental. Anesthesiology. 1975;43:402–409.
4. Beemer GH, Dawson PJ, Bjorksten AR, et al. Early postoperative seizures in neurosurgical patients administered atracurium and isoflurane. Anaesth Intens Care. 1989;17:504–509.
5. Bennett DR, Madsen JA, Jordan WS, et al. Ketamine anesthesia in brain damaged epileptics. Neurology. 1973;23:449–460.
6. Bone ME, Wilkins CJ, Lew JK. A comparison of propofol and methohexitone as anaesthetic agents for electroconvulsive therapy. Eur J Anaesthesiol. 1988;5:279–286.
7. Bredahl C. Seizures and opisthotonos after propofol anaesthesia. A possible connection. Ugesks Laeger. 1990;152:748–749.
8. Brunton LL. Agents affecting gastrointestinal water flux and motility, digestants and bile acids. In: Gillman A, Rall TW, Neis AS, et al., eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics, 8th ed. New York: McGrawHill; 1990:914–932.
9. Burchiel KJ, Stockard JJ, Calverly RK, et al. Electroencephalographic abnormalities following halothane anesthesia. Anesth Analg. 1978;57:244–251.
10. Burchiel KJ, Stockard JJ, Calverly RK, et al. Relationship of pre- and postanesthetic EEG abnormalities to enflurane-induced seizure activity. Anesth Analg. 1977;56:509–514.
11. Burchiel KJ, Stockard JJ, Myers RR, et al. Metabolic and electrophysiologic mechanisms in the initiation and termination of enflurane-induced seizures in man and cats. Electro- encephalogr Clin Neurophysiol. 1975;38:555.
12. Cameron AE. Opisthotonos again. Anaesthesia. 1987;42:1124.
13. Carney BT, Minter CL. Is operative blood loss associated with valproic acid? Analysis of bilateral femoral osteotomy in children with total involvement cerebral palsy. J Pediatr Orthop. 2005;25:283–5.
14. Cascino GD, So EL, Sharbrough FW, et al. Alfentanil-induced pileptiform activity in patients with partial epilepsy. J Clin Neurophysiol. 10;4:520–525.
15. Celesia GG, Chen RC, Bamforth BJ. Effects of ketamine in epilepsy. Neurology. 1975;25:169–172.
16. Chase RE, Holaday DA, Fiseroua-Bergerouva V, et al. The biotransformation of Ethrane in man. Anesthesiology. 1971;35:262–267.
17. Clark DL, Hosick EC, Adam N, et al. Neural effects of isoflurane (Forane) in man. Anesthesiology. 1973;39:261–270.
18. Clark DL, Rosner BS. Neurophysiologic effects of general anesthesics. I. The electroen- cephalogram and sensory evoked responses in man. Anesthesiology. 1973;38:564–582.
19. Constant I, Seeman R, Murat I. Sevoflurane and epileptiform EEG changes. Paediatr Anaesth. 2005;15:266–274.
20. Corseen G, Little S, Tavakoli M. Ketamine and epilepsy. Anesth Analg. 1974;53:319–335.
21. Darimont PC, Jenkins LC. The influence of intravenous anesthetics on enfluraneinduced central nervous system seizure activity. Can Anaesth Soc J. 1977;24(1):42– 56.
22. Doenicke AW, Roizen MF, Kugler J, et al. Reducing myoclonus after etomidate. Anesthesiology. 1999;90:113–119.
23. Ebrahim ZY, DeBoer GE, Lüders H, et al. Effect of etomidate on the electroencephalogram of patients with epilepsy. Anesth Analg. 1986;65:1004–1006.
24. Ellis Z, Bloomer C. Outpatient anesthesia for oral surgery in a juvenile with Leigh disease. Anesth Prog. 2005;52(2):70–73.
25. Ferrer-Allado T, Brechner VL, Dymond A, et al. Ketamine induced electroconvulsive phenomena in the human limbic and thalamic regions. Anesthesiology. 1973;38:333–344.
26. Flemming DC, Fitzpatrick J, Fariello RG, et al. Diagnostic activation of epileptogenic foci by enflurane. Anesthesiology. 1980;52:431–433.
27. Fuerst RH, Graves NM, Kriel RL, et al. Absorption and safety of rectally administered phenytoin. Eur J Drug Metab Pharmacokinet. 1988;13:257–260.
28. Galley AH. Unforeseen complications during dental anesthesia: fits and faints. Proc R Soc Med. 1966;59:734–738.
29. Graves NM, Kriel RL. Bioavailability of rectally administered lorazepam. Clin Neuropharmacol. 1987;10:555–559.
30. Graves NM, Kriel RL. Rectal administration of antiepileptic drugs in children. Pediatr Neurol. 1987;3:321–326.
31. Grob D, Harvey AM, Langworthy OR, et al. The administration of di-isopropyl flurophosphate (DFP) to man. III. Effect on central nervous system with special reference to the electrical activity of the brain. Johns Hopkins Hosp Bull. 1947;81:257–266.
32. Harrison JL. Postoperative seizures after isoflurane anesthesia. Anesth Analg. 1986;65:1235–1236.
33. Hodkinson BP, Frith RW, Mee EW. Propofol and the electroencephalogram. Lancet. 1987;8574:1518.
34. Holmes GB, Rosenfeld WE, Graves NM, et al. Absorption of valproic acid suppositories in human volunteers. Arch Neurol. 1989;48:906–909.
35. Hopkins CS. Recurrent opisthotonos associated with anaesthesia. Anaesthesia. 1988;43:905.
36. Iijima T, Nakamura Z, Iwao Y, et al. The epileptogenic properties of the volatile anesthetics sevoflurane and isoflurane in patients with epilepsy. Anesth Analg. 2000;91:989–95.
37. Ito BM, Sato S, Kufta CV, et al. Effect of isoflurane and enflurane on the electrocorticogram of epileptic patients. Neurology. 1988;38:924–928.
38. Jaaskelainen SK, Kaisti K, Suni L, et al. Sevoflurane is epileptogenic in healthy subjects at surgical levels of anesthesia. Neurology. 2003;61:1073–1078.
39. Jensen PK, Abild K, Poulsen MN. Serum concentration of clonazepam after rectal administration. Acta Neurol Scand. 1983;68:417–420.
40. Kofke WA, Snider MT, O'Connell BK, et al. Isoflurane stops refractory seizures. Anesthesiol Rev. 1987;15:58–59.
41. Kofke WA, Snider MT, Young RSK, et al. Prolonged low flow isoflurane anesthesia for status epilepticus. Anesthesiology. 1985;62:653–656.
42. Kofke WA, Templehoff R, Dasheiff RM. Anesthesia for epileptic patients and for epilepsy surgery. In: Cotrell JE, Smith DS, eds. Anesthesia and Neurosurgery. St Louis, MO: Mosby; 1994:495–524.
43. Konatsu H, Taie S, Syoiti E, et al. Electrical seizure during sevoflurane anesthesia in two pediatric patients with epilepsy. Anesth Analg. 1994;81:1535–1537.
44. Kreiger W, Copperman J, Laxer DL. Seizures with etomidate anesthesia. Anesth Analg. 1985;64:1226–1227.
45. Kurita N, Kawaguchi M, Hoshida T, et al. The effects of sevoflurane and hyperventilation on electrocorticogram spike activity in patients with refractory epilepsy. Anesth Analg. 2005;101:517–23.
46. Lebowitz MH, Blitt CS, Dillon JB. Clinical investigation of compound 374 (Ethrane). Anesth Analg. 1970;49:1–10.
47. Lin JTY, Ziegler DK, Lai CW, et al. Convulsive syncope in blood donors. Ann Neurol. 1982;11:525–528.
48. Loiseau P. Sodium valproate, platelet dysfunction, and bleeding. Epilepsia. 1981;22:141–146.
49. Lowson S, Gent JP, Goodchild CS. Anticonvulsant properties of propofol and hiopentone: comparison using two tests in laboratory mice. Br J Anaesth. 1990;64:59–63.
50. Manikandan S, Sinha PK, Neema PK, et al. Severe seizures during propofol induction in a patient with syringomyelia receiving baclofen. Anesth Analg 2005;100:1468–1469.
51. Manninen PH, Burke SJ, Wennberg R, et al. Intraoperative localization of an epileptogenic focus with alfentanil and fentanyl. Anesth Analg. 1999;88:1101–1106.
52. Masters LT, Perrine K, Devinsky O, et al. Wada testing in pediatric patients by use of propofol anesthesia. Am J Neuroradiol. 2000;21:1302–1305.
53. Miller-Pitt PL, Elcock BJ, Maharaj M. The management of status epilepticus with continuous propofol infusion. Anesth Analg. 1994;78(6):1193–1194.
54. Modica PA, Tempelhoff R, White PF. Pro- and anticonvulsant effects of anesthetics (part I and II). Anesth Analg. 1990;70:303–315, 433–444.
55. Moolenaar F, Bakker S, Visser J, et al. Biopharmaceutics of rectal administration of rugs in man. ix: Comparative biopharmaceutics of diazepam after single rectal, oral, intramuscular and intravenous administration in man. Int J Pharmacol. 1980;5:127–137.
56. Musella L, Wilder BJ, Schmidt RP. Electroencephalographic activation with intravenous methohexital in psychomotor epilepsy. Neurology. 1971;21:594–602.
57. Neigh JL, Garman JK, Harp JR. The electroencephalographic pattern during anaesthesia with Ethrane: effects of depth of anaesthesia, PaCO2, and nitrous oxide. Anesthesiology. 1971;35:482–487.
58. Nieminen K, Westeren-Punnonen S, Kokki H, et al. Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG. Br J Anaesth. 2002;89:853–856.
59. Oei-Lim VLB, Kelkman CJ, Bouvy-Berends EC, et al. A comparison of the effects of propofol and nitrous oxide on the electroencephalogram in epileptic patients during conscious sedation for dental procedures. Anesth Analg. 1992;75:708–714.
60. Ohm WW, Cullen BF, Amory DW, et al. Delayed seizure activity following enflurane anesthesia. Anesthesiology. 1975;42:367– 368.
61. Opitz A, Marschall M, Degan R, et al. General anesthesia in patients with epilepsy and status epilepticus. In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, et al, eds. Status Epilepticus: Mechanisms of Brain Damage and Treatment. New York: Raven Press; 1983:531–535.
62. Ornstein E, Matteo RS, Schwartz AE, et al. The effects of phenytoin on the magnitude and duration of neuromuscular block following atracurium or vecuronium. Anesthesiology. 1987;67:191–196.
63. Ornstein E, Matteo RS, Young WL, et al. Resistance to metocurine-induced neuromuscular blockade in patients receiving phenytoin. Anesthesiology. 1985;63:294–298.
64. Parent JM, Lowenstein DH. Treatment of refractory generalized status epilepticus with continuous infusion of midazolam. Neurology. 1994;44:1837–1840.
65. Paul R, Harris R. A comparison of methohexitone and thiopentone in electrocorticography. J Neurol Neurosurg Psychiatry. 1970;33:100–104.
66. Paxton JW. Effects of aspirin on serum phenytoin kinetics in healthy subjects. Clin Pharmacol Ther. 1980;27:170–178.
67. Rao TLK, Mummaneni N, El-Etr AA. Convulsions: An unusual response to intravenous fentanyl administration [Letter]. Anesth Analg. 1982;61:1020–1021.
68. Rockoff MA, Goudsouzian NG. Seizures induced by methohexital. Anaesthesiology. 1981;54:333–335.
69. Rudehill A, Gordon E, Grepe A, et al. The epileptogenicity of neurolept anesthesia in patients during and after neuroradiological examinations with metrizimide. Acta Anaesthesiol Scand. 1983;27:285–288.
70. Safwat AM, Daniel D. Grand mal seizure after fentanyl administration [Letter]. Anesthesiology. 1983;59:78.
71. Smith MC, Whisler WW, Morrell F. Neurosurgery of epilepsy. Semin Neurol. 1989;9(3):231–248.
72. Soriano SG, Kaus SJ, Sullivan LJ, et al. Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy. Paediatr Anaesth. 2000;10:133–136.
73. Tassinari CA, Dravet C, Roger J, et al. Tonic status epilepticus precipitated by intravenous benzodiazepine in five patients with Lennox-Gastaut syndrome. Epilepsia. 1972;13:421–435.
74. Templehoff R, Modica PA, Bernardo KL, et al. Fentanyl-induced electrographic seizures in patients with complex partial epilepsy. J Neurosurg. 1992;77:201–208.
75. Toman JEP, Davis JP. The effects of drugs upon the electrical activity of the brain. Pharmacol Rev. 1949;1:425–492.
76. Winter WD. Epilepsy or anesthesia with ketamine. Anesthesiology. 1972;36: 309–312.
Review
For citations:
Kotov A.E. MEDICAL MANIPULATIONS ON EPILEPTIC PATIENTS. Epilepsy and paroxysmal conditions. 2010;2(4):23-31. (In Russ.)
Views: 465
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
