Propofol: Pro- or Anticonvulsant Drug?

Meyer, Sascha; Grundmann, U.; Kegel, Britta; Gortner, Ludwig; Shamdeen, G

doi:10.1213/ane.0b013e3181a1f9ea

Cited by 16 publications

(4 citation statements)

References 9 publications

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“…Anesthetic drugs have an antiepileptic effect. Propofol has antiepileptic properties related to γ‐aminobutyric acid (GABA)–mediated presynaptic and postsynaptic inhibition, and thus decreases the release of glutamate and aspartate (Meyer et al., 2009, 2006). Propofol also blocks sodium and calcium current channels (Voss et al., 2008).…”

Section: Discussionmentioning

confidence: 99%

Epilepsy control following intracranial monitoring without resection in young children

et al. 2012

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Summary Purpose: Intracranial monitoring (IM) is a key diagnostic procedure for select patients with treatment‐resistant epilepsy (TRE). Seizure focus resection may improve seizure control in both lesional and nonlesional TRE. IM itself is not considered to have therapeutic potential. We describe a cohort of patients with improved seizure control following IM without resective surgery. Methods: Over 12.5 years, 161 children underwent 496 surgeries including intracranial monitoring. We retrospectively reviewed the patients’ charts, operative reports, and radiologic scans, under an institutional review board–approved protocol. Key Findings: Seventeen patients underwent only IM, without additional resective surgery, and seven had a dramatic improvement in their epilepsy; six of the seven patients are seizure‐free (Engel class I), and one rarely has seizures (Engel class II). All seven patients had frequent seizures that led to IM: either daily (five patients) or 1–2 per week (two patients). The mean age (± standard deviation, SD) at seizure onset was 1.6 ± 1.3 years (range 0.5–4 years). Etiologies were tuberous sclerosis (3 patients), trauma (1 patient), and unknown (3 patients). Mean age at surgery (± SD) was 4.1 ± 2 years (range 1–7 years), and duration of epilepsy 2.5 ± 1.1 years (range 0.5–4 years). Duration of IM was 11.7 ± 5.6 days (5–19 days). Six patients had bilateral and one unilateral invasive electrodes. At last follow‐up, four patients required fewer antiepileptic drugs (AEDs), one had the same medication but a higher dose, and two patients were taking additional AEDs. Follow‐up was 30.6 ± 9.5 months (range 19–41 months). Significance: Although uncommon, patients with TRE may improve after IM alone. The explanation for this observation remains unclear; however, perioperative medications including steroids, direct cortical manipulation, or other factors may influence the epileptogenic network.

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Section: Discussionmentioning

confidence: 99%

Epilepsy control following intracranial monitoring without resection in young children

et al. 2012

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“…17,18 Transient excitatory phenomena are seen occasionally (e.g., myoclonus, opisthotonus, tonic-clonic activity), during induction or recovery when blood levels are low, and presumably at a time when inhibitory centers but not excitatory centers have been depressed. 5,19,20 Onset of action: 30 sec. Time to peak effect: 5 min.…”

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confidence: 99%

Propofol

Lundström

Twycross

Mihalyo

et al. 2010

Journal of Pain and Symptom Management

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Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. The content is also available on www.palliativedrugs.com and will feature in future editions of the Hospice and Palliative Care Formulary USA and its British and Canadian counterparts. The series editors welcome feedback on the articles (hq@palliativedrugs.com).

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“…7,8 Yet propofol is felt to have net anticonvulsant properties. 9 Previous studies have evaluated dose-dependent EEG changes during the use of propofol sedation including generalized spikes, generalized slowing, focal spikes, and suppression of spike-wave patterns but have not reported on fast activity. 8 Similarly, little is known about the influence of the rate of propofol infusion on EEG fast activity.…”

Section: Discussionmentioning

confidence: 99%

Propofol’s EEG Fast Activity is Dose-Dependent

Asato,

Shin,

Gragas

et al. 2023

SVOAPD

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Introduction: For patients with a first-time suspected seizure, electroencephalograms (EEG) are part of the initial evaluation. Most sedatives result in EEG artifact “fast activity” (FA), making the EEG difficult to read. During propofol-sedated EEGs, we noticed that FA would diminish when the propofol infusion rate was low. The purpose of this study is to investigate propofol dosing and its relationship to EEG FA artifact. Methods: This study involved retrospective chart reviews of a pediatric database for sedated EEG encounters in patients under 7 years of age. Data was collected from a total of 55 charts. Total doses of propofol (mg/kg/hr) were calculated for the first half and second half. The actual EEGs were reviewed by a pediatric neurologist study investigator, to classify the degree of FA as: none, mild, moderate, severe. We then examined whether total doses of propofol given during the EEG (mg/kg/hr) halves affected the severity of FA using ordinal logistic regression. Results: The results are summarized in Table 1, which shows that propofol doses (paired T-test, p<0.001) and EEG FA (Bowker’s test of symmetry, p=0.002) were higher in the first half compared to the second half. Figure 1 graphs each data point independently, which shows via linear and ordinal logistic regression a positive relationship between propofol dosing and FA severity (p=0.0014, OR=1.20, 95% CI=1.08-1.34, respectively). Results: The results are summarized in Table 1, which shows that propofol doses (paired T-test, p<0.001) and EEG FA (Bowker’s test of symmetry, p=0.002) were higher in the first half compared to the second half. Figure 1 graphs each data point independently, which shows via linear and ordinal logistic regression a positive relationship between propofol dosing and FA severity (p=0.0014, OR=1.20, 95% CI=1.08-1.34, respectively).

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Propofol: Pro- or Anticonvulsant Drug?

Cited by 16 publications

References 9 publications

Epilepsy control following intracranial monitoring without resection in young children

Epilepsy control following intracranial monitoring without resection in young children

Propofol

Propofol’s EEG Fast Activity is Dose-Dependent

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