It Is Not Necessary to Discontinue Seizure Threshold–Lowering Medications Prior to Myelography

Abstract

BACKGROUND AND PURPOSE: There is no consensus on whether patients undergoing myelography should discontinue medications that could lower their seizure threshold. The purpose of this study was to document the most commonly prescribed seizure thresholdlowering medications in patients undergoing myelography and determine whether withholding such medications decreases the incidence of seizures. MATERIALS AND METHODS: We performed a retrospective observational study of all the myelograms obtained in 2016 at 2 affiliated hospitals. At hospital A, seizure threshold-lowering medications are discontinued before myelography, and prophylactic diazepam is given for all cervical myelograms. At hospital B, seizure threshold-lowering medications are not withheld before the procedure, and medical seizure prophylaxis is not implemented. The seizure threshold-lowering medications the patients were taking at the time of the procedure and postmyelographic seizure incidence were documented. RESULTS: A total of 311 patients underwent myelography during 2016. One hundred eleven patients (36%) were on at least 1 seizure threshold-lowering medication, and 30 (10%) were on at least 2. The most common medications were duloxetine, sertraline, venlafaxine, bupropion, and trazodone. The most common tricyclic antidepressant was amitriptyline. Three patients across both sites had a controlled seizure disorder and were on antiepileptics. None of the patients at either hospital had seizures during or within 3 hours following any of the myelograms during the study period. CONCLUSIONS: Continuing seizure threshold-lowering medications during myelography does not increase the risk of seizures. Screening for and withholding seizure threshold-lowering medications are not indicated for routine myelography.

Preoperative Evaluation of Patients with Neurological Disorders

“…Many of these medications can have sedative side effects or inhibit liver enzymes leading to oversedation. Additionally, proconvulsant medications should be limited intraoperatively and postoperatively including ketamine, methohexital, meperidine, and tramadol [9,[14][15][16][17] (Table 11.1). However, some controversy exists as to whether the use of ketamine is a relative or absolute contraindication, as the literature is not conclusive of this particular issue.…”