[EEG activation with bemegride in epilepsy diagnosis. 1: Literature review]

In patients with suspected epilepsy, an EEG "activation" with bemegride can be performed as last link of the diagnostic chain. The administration of bemegride intends the activation of epileptiform discharges in the EEG of patients with a disposition for epilepsy. This activation is not supposed to occur in healthy subjects at the same dosage. The occurrence of generalized and focal epileptiform discharges during the intravenous administration of bemegride is regarded as a positive test result by most investigators. Changes like a slowing of the background activity, dysrhythmias, parenrhythmias, and focal changes are not reliable. The provocation of seizures should be avoided. Dosage and injection rate must be chosen in such a way that false negative results are more probable than false positive. The result of the bemegride test is influenced by sex, type of seizures, age and alcohol intake. Slight side effects of the intravenous administration of bemegride are relatively common, severe side effects rather uncommon when the test is carefully performed. According to the literature and personal experience, the activation of typical epileptiform discharges in the EEG by bemegride in adults with doubtful episodes of unconsciousness indicates the possible presence of epilepsy (epileptic seizures respectively), but does not confirm this. In our opinion, the bemegride test is contraindicated in patients with established epilepsy (epileptic seizures respectively) or in cases in whom the occurrence of epileptic seizures is probable.