Seizure-like phenomena and propofol: a systematic review

Area of Science:

• Anesthesiology
• Neuroscience
• Pharmacology

Background:

• Propofol is a widely used anesthetic agent.
• Seizure-like phenomena (SLP) have been anecdotally reported in patients receiving propofol.
• The relationship between propofol administration and SLP requires further investigation.

Purpose of the Study:

• To systematically review and classify SLP in patients who received propofol.
• To analyze the timing and clinical presentation of SLP during and after propofol administration.
• To explore potential correlations between propofol and SLP.

Main Methods:

• Systematic review of case reports detailing SLP in propofol-recieving patients.
• Classification of SLP based on occurrence time (induction, maintenance, emergence, delayed) and clinical presentation.
• Analysis of patient data, including epilepsy status and diagnostic workup (EEG, neurological consultation).

Main Results:

• SLP occurred in 70 patients without epilepsy (34% induction, 40% emergence, 23% delayed) and 11 patients with epilepsy (64% during emergence).
• Most common presentations included generalized tonic-clonic seizures (43%), increased tone with twitching (36%), and involuntary movements (16%).
• Diagnostic workup was limited, with only 32% having an EEG and 15% a neurological consultation.

Conclusions:

• SLP can manifest in patients with or without epilepsy during propofol anesthesia or sedation.
• The temporal occurrence of SLP suggests a potential link to fluctuating propofol cerebral concentrations.
• Higher quality data is essential to confirm causality, determine prevalence, and identify risk factors for propofol-related SLP.