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Exploring postictal recovery with acetaminophen or nimodipine: A randomized-controlled crossover trial
Julia C M Pottkämper1,2,3,4, Joey P A J Verdijk1,2, Sven Stuiver1,2
1Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.
Annals of Clinical and Translational Neurology
|August 20, 2024
Summary
Acetaminophen and nimodipine did not improve postictal EEG recovery or clinical reorientation after ECT-induced seizures. Further study of the postictal state is feasible.
Area of Science:
- Neurology
- Clinical Trials
- Epilepsy Research
Background:
- The postictal state, the period following a seizure, is often underrecognized.
- Animal models suggest acetaminophen and nimodipine may improve postictal symptoms and cerebral perfusion.
Purpose of the Study:
- To investigate the effects of acetaminophen or nimodipine on postictal electroencephalographic (EEG) recovery, clinical reorientation, and hypoperfusion in patients undergoing electroconvulsive therapy (ECT)-induced seizures.
Main Methods:
- A prospective, randomized crossover trial involving 33 patients undergoing ECT.
- Participants received oral acetaminophen (1000 mg), nimodipine (60 mg), or placebo 2 hours before ECT sessions.
- Primary outcome was postictal EEG recovery speed; secondary outcomes included EEG recovery extent, clinical reorientation time, and cerebral blood flow via MRI.
Main Results:
- Neither acetaminophen nor nimodipine significantly altered the speed or extent of postictal EEG recovery compared to placebo.
- No significant differences were observed in clinical reorientation time or postictal cerebral blood flow.
- Longer seizures correlated with slower EEG recovery and reduced postictal perfusion; nimodipine showed regional perfusion changes in the posterior cortex.
Conclusions:
- Pretreatment with acetaminophen or nimodipine did not alleviate postictal state symptoms or signs in patients with ECT-induced seizures.
- The study demonstrates the feasibility of systematically investigating the postictal state in this patient population.
