Alfentanil‐Induced Epileptiform Activity: A Simultaneous Surface and Depth Electroencephalographic Study in Complex Partial Epilepsy

Ross, John F.; Kearse, Lee A.; Barlow, M. K.; Houghton, Kerry; Cosgrove, G. Rees

doi:10.1046/j.1528-1157.2001.18600.x

Cited by 10 publications

(3 citation statements)

References 31 publications

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“…24,31 Many studies have identified increased ECoG IED activation and seizures with administration of alfentanil or remifentanil. 24,25,31-34 We have previously investigated this effect and reported that IED activation was most prominent in individuals having the fewest IEDs at baseline. 24 These previous opioid-induced ECoG-related studies were performed in patients with MTS and did not investigate surgical outcome, prompting us to undertake the current study.…”

Section: Discussionmentioning

confidence: 98%

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

et al. 2014

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IMPORTANCE Scalp electroencephalography (EEG) and intraoperative electrocorticography (ECoG) are routinely used in the evaluation of magnetic resonance imaging-negative temporal lobe epilepsy (TLE) undergoing standard anterior temporal lobectomy with amygdalohippocampectomy (ATL), but the utility of interictal epileptiform discharge (IED) identification and its role in outcome are poorly defined.OBJECTIVES To determine whether the following are associated with surgical outcomes in patients with magnetic resonance imaging-negative TLE who underwent standard ATL:(1) unilateral-only IEDs on preoperative scalp EEG; (2) complete resection of tissue generating IEDs on ECoG; (3) complete resection of opioid-induced IEDs recorded on ECoG; and (4) location of IEDs recorded on ECoG. DESIGN, SETTING, AND PARTICIPANTS Data were gathered through retrospective medical record review at a tertiary referral center. Adult and pediatric patients with TLE who underwent standard ATL between January 1, 1990, and October 15, 2010, were considered for inclusion. Inclusion criteria were magnetic resonance imaging-negative TLE, standard ECoG performed at the time of surgery, and a minimum follow-up of 12 months. Univariate analysis was performed using log-rank time-to-event analysis. Variables reaching significance with log-rank testing were further analyzed using Cox proportional hazards. MAIN OUTCOMES AND MEASURES Excellent or nonexcellent outcome at time of last follow-up. An excellent outcome was defined as Engel class I and a nonexcellent outcome as Engel classes II through IV.RESULTS Eighty-seven patients met inclusion criteria, with 48 (55%) achieving an excellent outcome following ATL. Unilateral IEDs on scalp EEG (P = .001) and complete resection of brain regions generating IEDs on baseline intraoperative ECoG (P = .02) were associated with excellent outcomes in univariate analysis. Both were associated with excellent outcomes when analyzed with Cox proportional hazards (unilateral-only IEDs, relative risk = 0.31 [95% CI, 0.16-0.64]; complete resection of IEDs on baseline ECoG, relative risk = 0.39 [95% CI, 0.20-0.76]). Overall, 25 of 35 patients (71%) with both unilateral-only IEDs and complete resection of baseline ECoG IEDs had an excellent outcome. CONCLUSIONS AND RELEVANCEUnilateral-only IEDs on preoperative scalp EEG and complete resection of IEDs on baseline ECoG are associated with better outcomes following standard ATL in magnetic resonance imaging-negative TLE. Prospective evaluation is needed to clarify the use of ECoG in tailoring temporal lobectomy.

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Section: Discussionmentioning

confidence: 98%

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

et al. 2014

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“…However, all the studies demonstrating this epileptogenic effect used high doses of alfentanil and were performed in epileptic subjects, a population very different from ours. [41][42][43][44][45] Moreover in epileptic patients, alfentanil failed to induce any epileptic activity in healthy areas of the brain. 46 In a 36-yr-old man with intractable epileptic seizures, anesthetized with 1.5% sevoflurane, the injection of 0.1 mg/kg of fentanyl reduced the frequency of spike waves.…”

Section: Discussionmentioning

confidence: 99%

Epileptogenic Effect of Sevoflurane

et al. 2012

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“…[3][4][5][6] Opioids are often used to localize the epileptogenic focus in adult patients. [7][8][9][10] For example, alfentanil facilitates intraoperative ECoG-guided localization of the epileptogenic focus during seizure surgery. [11][12][13] However, the effect of alfentanil on ECoG in pediatric patients with seizure disorder has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Effect of Alfentanil on the Intraoperative Localization of an Epileptogenic Focus in Pediatric Patients with Intractable Seizure Disorder

Choi

Lee

et al. 2007

Korean J Anesthesiol

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Background: Intraoperative alfentanil is known to increase the epileptic discharge in the adult seizure patients. This study hypothesized that alfentanil might localize an epileptogenic focus in pediatric seizure patients.Methods: This study was performed in the pediatric seizure patients who undergo second-staged operation. Thirteen pediatric patients were enrolled and their epileptic foci were already suspected from first operation. After anesthetic induction, sevoflurane was maintained at 0.6% end-tidal concentration for study period. Electrocorticography (ECoG) was recorded for 5 minutes before and 5 minutes after alfentanil 20μg/kg IV. During the ECoG recordings, the mean arterial pressure (MAP) and heart rate (HR) were continuously monitored. After the surgery, a pediatric neurologist analyzed the changes of spike frequencies of suspected ictal zone. The spike frequencies of suspected non-ictal zone were also calculated in five patients. The suspected ictal zone was defined as the most abundant spontaneous spiking area observed after first staged grid insertion.Results: Alfentanil induced a significant increase in spike activity of suspected ictal zone in 12 out of 13 patients (median of 20 [ranged 10 to 100] vs 38 [ranged 20 to 100], P ＜ 0.05). Alfentanil-induced increase of spike activity was prominent in the suspected ictal zone rather than non-ictal zone. There were no significant changes in the MAP and HR after administration of alfentanil.Conclusions: Alfentanil activates epileptiform activity of suspected ictal zone in pediatric patients with seizure disorder and can be used to assist in the localization of the epileptogenic focus during seizure surgery.

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Alfentanil‐Induced Epileptiform Activity: A Simultaneous Surface and Depth Electroencephalographic Study in Complex Partial Epilepsy

Cited by 10 publications

References 31 publications

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

Interictal Scalp Electroencephalography and Intraoperative Electrocorticography in Magnetic Resonance Imaging–Negative Temporal Lobe Epilepsy Surgery

Epileptogenic Effect of Sevoflurane

Effect of Alfentanil on the Intraoperative Localization of an Epileptogenic Focus in Pediatric Patients with Intractable Seizure Disorder

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