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Alfentanil-induced epileptiform activity: a simultaneous surface and depth electroencephalographic study in complex
J Ross1, L A Kearse, M K Barlow
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. jels@massmed.org
Epilepsia
|March 10, 2001
Summary
Alfentanil can induce seizures in patients with complex partial epilepsy (CPE). These seizures may be subclinical, detected only by depth EEG, highlighting the need for caution during anesthesia induction in CPE patients.
Area of Science:
- Neuroscience
- Anesthesiology
- Epileptology
Background:
- Opiate receptor agonists, like alfentanil, are used in anesthesia.
- Proconvulsant effects are known in animals but inconsistently shown in humans.
- Previous human EEG studies have yielded conflicting results regarding epileptiform activity induction.
Purpose of the Study:
- To investigate the proconvulsant effects of alfentanil in patients with complex partial epilepsy (CPE).
- To compare scalp EEG with depth EEG during alfentanil administration.
- To explore the relationship between alfentanil dose and epileptiform activity.
Main Methods:
- Simultaneous scalp and depth EEG recordings were used in five CPE patients.
- Alfentanil was administered in consecutive, equal bolus doses at timed intervals.
- Patients received alfentanil for anesthesia induction prior to depth electrode removal.
Main Results:
- Alfentanil induced epileptiform activity in three out of five patients.
- Electrographic seizures occurred in two patients.
- Activity was exclusively detected by depth electrodes, appearing within 2 minutes of the initial dose.
Conclusions:
- Alfentanil demonstrates proconvulsant properties in CPE patients.
- Induced seizures can be subclinical, without scalp EEG correlation.
- Caution is advised when using alfentanil for anesthesia induction in patients with CPE.