Electroencephalography of Seizure-Like Movements During General Anesthesia with Propofol: Seizures or Nonepileptic Events?

Seizure-like behavior is an uncommon yet worrisome phenomenon during anesthesia with propofol. The current case report describes a 23-year-old man admitted for elective surgery who experienced several seizure-like episodes after induction with propofol and during a desflurane-based general anesthetic that were so severe it was not possible to complete the procedure. A second surgery was rescheduled 2 days later with simultaneous scalp electroencephalographic (EEG) recording and general anesthesia with propofol and fentanyl. During the second operation, he again experienced numerous episodes of generalized shaking movements. Simultaneous intraoperative EEG recording showed a background of diffuse beta and alpha frequencies interspersed with periods of pseudoperiodic delta activity; electrographic seizures were not apparent. With this information, muscle relaxants were given and the procedure was performed without difficulty. This is the first report of apparent seizure-like activity during anesthesia with propofol of an otherwise relatively healthy adult, in which concurrent EEG recording demonstrates the nonepileptic nature. The current case demonstrates that, at least in some instances, these concerning movements are not seizure related. Concurrent EEG monitoring may be helpful to evaluate the nature of the episodes in select cases.