Anaesthesia and epilepsy

Abstract

Epilepsy is the most common serious neurological disorder, with a prevalence of 0.5-1% of the population. While the traditional antiepileptic drugs (AEDs) still play a significant role in treatment of seizures, there has been an influx of newer agents over the last 20 yr, which are now in common usage. Anaesthetists are frequently faced with patients with epilepsy undergoing emergency or elective surgery and patients suffering seizures and status epilepticus in the intensive care unit (ICU). This review examines perioperative epilepsy management, the mode of action of AEDs and their interaction with anaesthetic agents, potential adverse effects of anaesthetic agents, and the acute management of seizures and refractory status epilepticus on the ICU. Relevant literature was identified by a Pubmed search of epilepsy and status epilepticus in conjunction with individual anaesthetic agents.

Remarkable alterations of Nav1.6 in reactive astrogliosis during epileptogenesis

“…Epilepsy is one of the most common neurological diseases with a prevalence of 0.5–2% of the population worldwide, which is characterized by the periodic and unprovoked occurrence of seizures that manifest neuronal hypersynchrony and hyperexcitability1. Although seizures in many patients with epilepsy can be well-controlled with currently available antiepileptic drugs (AEDs), a substantial proportion (~30%) of patients who do not respond to any AEDs will ultimately develop intractable epilepsy2.…”

Preoperative and Postoperative Care of Patients with Neurologic Disorders

“…41 Intravenous anesthetics including barbiturates and propofol are used for the treatment of status epilepticus, but at induction have been reported to be excitatory and can rarely precipitate a seizure. 42 Some opioids, particularly meperidine and to a lesser extent fentanyl, have been linked to seizures, especially with intrathecal use. 42 Propofol and opioids can also cause myoclonus and tremulousness that may clinically mimic seizures.…”

“…42 Some opioids, particularly meperidine and to a lesser extent fentanyl, have been linked to seizures, especially with intrathecal use. 42 Propofol and opioids can also cause myoclonus and tremulousness that may clinically mimic seizures. Neuromuscular blocking agents have not been linked to seizures; however, if seizures are suspected while these drugs are being administered, continuous electroencephalographic monitoring is required as clinical manifestations of seizures will be masked.…”

“…42 Studies investigating regional blockade in patients with epilepsy have concluded that perioperative seizures were not increased in frequency. 36 Postoperative seizures should be considered as an etiology for delayed awaking after anesthesia.…”

A novel detachable head-mounted device for simultaneous EEG and photoacoustic monitoring of epilepsy in freely moving rats

“…Optical mapping methods such as optical recording of intrinsic signals (ORIS), optical coherence tomography (OCT) and voltage sensitive dye require large craniotomies due to their limited imaging depth (Ma et al, 2013;Eberle et al, 2012). One limitation with anesthetized animals is that anesthesia suppresses spontaneous neural activities thereby altering both the neural and vascular responses during seizures (Perks et al, 2012). As a consequence awake and freely moving animals with vascular response uninterrupted by extrinsic factors are preferred.…”