Anesthesia-induced epilepsy: causes and treatment

Abstract

Epilepsy is a type of chronic brain disease that results from an abnormally high synchronization of neuronal discharge. The typical clinical features of epilepsy are paroxysms and transient and stereotyped brain dysfunction. Many cases of epileptic seizures occurring during anesthesia have been reportedx. Recently, risk assessment of epileptic seizures during surgery and anesthesia has gained increasing attention. In this review, we systematically summarize the influence of anesthesia on epileptic seizures; the types, durations and frequencies of seizures related to anesthesia; and the epidemiology, prevention, treatment and prognosis of epilepsy. We also explore the possible mechanism of epilepsy and provide guidance for anesthesia during surgeries.

Keywords::

• anesthesia
• anesthetic
• epilepsy
• epileptic seizure
• mechanism

Acknowledgements

The authors wish to thank K Jeffrey and S Kelly who provided language assistance.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The epidemiological characteristics of epileptic seizures that occur under anesthesia require study.

• In recent years, there have been at least 300 case reports on anesthesia-related seizures.

• The characteristics of seizures that occur under different anesthetics, including the timing of seizures, the types of seizures, the relationship between seizures and the concentration of anesthetics, require further study.

• The epileptic mechanisms related to anesthesia require further exploration. For example, the mechanisms related to neurotransmitters, ion channels, lack of balance between excitement and inhibition, high-frequency oscillations, gap junction mechanism, etc., require further investigation.

• A treatment scheme for perioperative seizures needs to be established.

• Methods for effectively preventing seizures under anesthesia need to be identified. Here, we explored drug interactions between anesthetics and antiepileptic drugs (AEDs), compared different anesthetics and proposed a method for choosing the safest anesthetics and AEDs.

• Prophylaxis against anesthetic epilepsy was discussed from three aspects: the common prophylaxis, choosing the safest AEDs and anesthetics for high-risk patients.

Notes

A: Low-concentration sevoflurane (<1.5 MAC); B: High-concentration sevoflurane (≥1.5 MAC); C: Isoflurane (1 MAC); D: Low-concentration desflurane (<1.5 MAC); E: High-concentration desflurane (≥1.5 MAC); F: Low-concentration sevoflurane/isoflurane + midazolam/50% N₂O; G: Enflurane; MAC: Minimum alveolar concentration.

MAC: Minimum alveolar concentration.