Effect of propofol on seizure‐like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties

Abstract

There is an ongoing debate as to whether propofol exhibits pro-or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure-like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure-like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23 ⁄ 25 children), and suppression of pre-existing theta rhythms (11 ⁄ 16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike-wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike-wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike-wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time-dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative-hypnotic agent with anticonvulsant properties as shown by depression of spike-wave patterns in children with epilepsy and by the absence of seizure-like phenomena of epileptic origin.

Prolonged myoclonus after a single bolus dose of propofol

“…There are reports of its ability to terminate status epilepticus [17,18]. The beneficial effects of propofol on epilepsy may be related to its depressant effect on the central nervous system, involving GABA, glutamate and aspartate mechanisms [6].…”

“…Fentanyl [19,20] and sevoflurane [21] may cause neurological complications but as far as we are aware, association with opisthotonus and myoclonus has not been described. In contrast, propofol has frequently been reported to cause this movement disorder [1,2,4,[6][7][8]. Seizure-like phenomena associated with propofol remain the likely cause after excluding other possibilities.…”

“…It is also commonly used as a sedative for surgical procedures and in the Intensive Care Unit (ICU). Although propofol has been used as an anticonvulsant, there have been reports of seizure-like phenomena associated with its administration [1][2][3][4][5][6][7][8]. This neurological side effect is usually short lived, but in some patients it may persist for weeks [5].…”

Anesthesia-related status epilepticus after fiber optic colonoscopy in a child

“…The debate is ongoing regarding whether propofol exhibits pro-or anticonvulsant effects [11], and whether it should be used in patients with epilepsy [12,13]. Prudence suggests that patients who experience SLP should not be given propofol SOR-MED S. Shu: Anesthesia-related status epilepticus after fiber optic colonoscopy in a child again.…”

Sedation and analgesia for brief diagnostic and therapeutic procedures in children

“…Propofol [15,16,22,40,61] Propofol, an intravenous lipid-based global central nervous depressant with a modulating action on GABA A receptors (by enhancing inward GABA A Cl − currents) was first introduced in 1980, and is nowadays commonly used for sedation as well as for induction and maintenance of general anaesthesia in children and adults. It has a rapid sedation onset with a dose-related hypnotic effect and a quick and smooth recovery profile.…”