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Anesth Analg 2007; 105:1509-1510
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000287022.90580.66
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LETTER TO THE EDITOR

Effect of Propofol on Interictal Epileptiform Activity

Sascha Meyer, MD, Ulrich Grundmann, MD, Ghiath Shamdeen, MD, Sven Gottschling, MD, and Ludwig Gortner, MD

Department of Pediatrics and Neonatology; sascha.meyer{at}uniklinik-saarland.de (Meyer) Department of Anesthesiology and Intensive Care Medicine (Grundmann) Department of Neuropediatrics (Shamdeen) Department of Pediatrics and Neonatology; University Hospital of the Saarland; Homburg, Germany (Gottschling, Gortner)

To the Editor:

In a recent article describing the effect of general anesthetics on the successful detection of interictal epileptiform activity in magnetoencephalography (1), the authors report that propofol did not affect the occurrence of interictal activity in patients with epilepsy (age 1–48 yr; 38 children: 74% {lsqb;anesthesia{rsqb; versus 80% {lsqb;no anesthesia{rsqb;) undergoing magnetoencephalography. This is somewhat in line with a recent study, which demonstrated that propofol possesses antiepileptic activity (suppression of spike-wave patterns) in children with epilepsy (2).

However, the conclusions that can be derived from both studies are limited by the fact that neither study recorded electoencephalographic activity at the beginning of propofol administration and after discontinuing propofol (1,2). A systematic review demonstrated a predominance of seizure-like phenomena during induction, emergence or delayed after anesthesia or sedation with only few events during maintenance (3). This may be related to two issues: first, propofol plasma concentrations remain stable during the maintenance phase, suggesting that seizure-like phenomena tend to occur during changes of blood and brain tissue levels of propofol. Second, during maintenance of anesthesia or sedation, there is usually no change in the conscious state and thus probably less cerebral excitation that may serve as a promoter for seizures. Therefore, in future trials it will be important to record interictal epileptiform activity at the beginning, during, and after propofol anesthesia.

We would also like to inform you that a drug dosage error has occurred in the published manuscript and assumed that the propofol dose should read 50–150 µg · kg–1 · min–1.

REFERENCES

  1. Balakrishnan G, Grover KM, Mason K, Smith B, Barkley GL, Tepley N, Bowyer SM. A retrospective analysis of the effect of general anesthetics on the successful detection of interictal epileptiform activity in magnetoencephalography. Anesth Analg 2007;104:1493–7[Abstract/Free Full Text]
  2. Meyer S, Shamdeen MG, Kegel B, Mencke T, Gottschling S, Gortner L, Grunmann U. Effect of propofol on seizure-like phenomena and elecetroencephalographic activity in children with epilepsy vs. children with learning difficulties. Anaesthesia 2006;61:1040–7[Web of Science][Medline]
  3. Walder B, Tramèr MR, Seeck M. Seizure-like phenomena and propofol. A systematic review. Neurology 2002;58:1327–32[Abstract/Free Full Text]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press