Perioperative implications of caring for patients with epilepsy

Published on 07/02/2015 by admin

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Last modified 07/02/2015

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Perioperative implications of caring for patients with epilepsy

C. Thomas Wass, MD

Epilepsy is one of the most common neurologic disorders, with a prevalence approaching 1% of the population; nearly 3 million people in the United States have a seizure disorder. Seizures are characterized based primarily on the clinical manifestation and electroencephalographic (EEG) features (Box 138-1).

Box 138-1

Classification of Seizures*

*Seizure that cannot be clearly diagnosed into one of the preceding categories should be considered unclassified until further information allows their accurate diagnosis. This is not considered a classification category. however.

Bert AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010: 51(4): 676-685.

Anecdotal observations and case reports suggest that the process of anesthesia and surgery is associated with increased perioperative seizure activity (frequency and duration). Proposed etiologic factors include withholding antiepileptic drugs (AEDs) because of the patient’s NPO (nil per os) status prior to surgery, hypoglycemia, hyponatremia, hyperpyrexia, sleep deprivation, fatigue, stress, excessive alcohol consumption, and use of proconvulsant medications. Anesthetics (discussed in greater detail later) implicated in this response include inhalation anesthetic agents, local anesthetic agents (e.g., lidocaine, bupivacaine), opioids (e.g., fentanyl, alfentanil, sufentanil, meperidine), and some sedative-hypnotic medications (e.g., etomidate, ketamine, methohexital). Considering that these drugs are administered to most patients requiring general anesthesia, it is imperative to understand the effects of anesthetic agents on individuals with seizure disorders. Anesthesia providers must have an understanding of the implications of caring for patients with epilepsy who require anesthesia for non-neurosurgical operations, as well as the intricacies of providing anesthesia for patients with epilepsy undergoing resection of an epileptogenic focus.

Perioperative seizure frequency

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