Anesthetic management of the patient with epilepsy or prior seizures

W. Andrew Kofke

Research output: Contribution to journalReview articlepeer-review

54 Scopus citations


Purpose of review: Epilepsy is a clinical disorder of paroxysmal recurring seizures, the diagnosis excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. Recent findings: New antiepileptic drugs (AEDs) have been a major change in the approach to management of patients with epilepsy. These drugs tend to have fewer significant drug interactions and less severe side effects. Nonetheless, first-generation AEDs are still widely used. Propofol and desflurane have reliable anticonvulsant effects, whereas remifentanil in larger doses and sevoflurane appear to support epileptiform activity, although the clinical significance of these observations is unclear. Summary: The primary concerns for providing anesthesia to the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with AEDs. Proconvulsant and anticonvulsant properties have been reported for virtually every anesthetic such that these properties become elements of the anesthetic plan in the patient with epilepsy. Moreover, AEDs have many physiologic and pharmacologic effects that can have an impact on an anesthetic.

Original languageEnglish (US)
Pages (from-to)391-399
Number of pages9
JournalCurrent opinion in anaesthesiology
Issue number3
StatePublished - Jun 2010

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine


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