Prolonged myoclonus after a single bolus dose of propofol

Abstract

SummaryPropofol is a commonly used anaesthetic agent and is rarely associated with seizure-like phenomena. This case report presents a young woman with seizure-like phenomena lasting more than 4 weeks after a single dose of propofol. The underlying pathophysiology of this condition is poorly understood but a psychological component is possible in this case.

Myoclonus in the critically ill: Diagnosis, management, and clinical impact

“…In contrast to epileptic myoclonus, syncope-related myoclonus appears multifocal (Lempert et al, 1994) after the Table 1 The classification of myoclonic movements (based on the work of Fahn et al (Dijk and Tijssen, 2010;Fahn, 2002) Intoxication/drug-related encephalopathy Anesthetic drugs Etomidate (Laughlin and Newberg, 1985;Lumley and Morgan, 1985) Propofol (Tam et al, 2009) Enflurane (Ng, 1980) Opioids Hydromorphone (Babul and Darke, 1992;Patel et al, 2006) Morphine (Potter et al, 1989) Fentanyl (Stuerenburg et al, 2000) Nonsteroidal anti-inflammatory drugs Diclofenac (Bandelot and Mihout, 1978) …”

“…Treatment-related interferences result from several drugs that are frequently used in intensive care as mentioned earlier (Table 2). Although some anesthetics can trigger or aggravate myoclonus including etomidate (Laughlin and Newberg, 1985;Lumley and Morgan, 1985), propofol (Tam et al, 2009), and enflurane (Ng, 1980), deep anesthesia and muscle relaxants attenuate myoclonus.…”

Propofol effects on cerebellar long-term depression

“…In addition, propofol produces a hypnotic effect by suppressing neuronal activity, and an amnesic effect via impaired hippocampal long-term potentiation and facilitated long-term depression (LTD) [21]. Especially, propofol has other adverse effects that cause prolonged movement disorders including dystonia, myoclonus and ataxia [3,5,25,27]. However, the mechanisms of these movement disorders have not been identified.…”

Cortical reflex myoclonus

“…Myoclonus is defined as sudden, brief, abrupt twitching of body parts, usually involving the face, extremities, and trunk . It has diverse multifactorial aetiologies, including neurodegenerative and systemic metabolic disorders, central nervous system infections , and can follow administration of a large number of drugs , including etomidate and propofol . Myoclonus is a rare complication of neuraxial anaesthesia .…”