Portal de Periódicos da CAPES

Propofol: Pro- or Anticonvulsant Drug?

2009; Lippincott Williams & Wilkins; Volume: 108; Issue: 6 Linguagem: Inglês

10.1213/ane.0b013e3181a1f9ea

1526-7598

Sascha Meyer, U. Grundmann, Britta Kegel, Ludwig Gortner, Ghiath M. Shamdeen,

Neuroscience and Neuropharmacology Research

To the Editor: As part of a review discussing the occurrence of seizures associated with general anesthetics, Voss et al.1 stated that it is still unclear whether propofol is pro- or anticonvulsant. The typical electroencephalogram pattern after propofol sedation in healthy subjects is an initial increase in frequency from α to β waves, followed by a slowing to δ waves.2,3 In our prospective study,4 we demonstrated distinct electroencephalogram patterns after propofol-induced sedation in children with epilepsy and children with learning difficulties. Whereas children with learning difficulties did not develop spike-wave patterns, the most notable characteristic seen in children with epilepsy was suppression of spike-wave patterns. None of our study patients developed seizure-like phenomena. The effects of propofol on epileptic discharge and seizure activity may be related to its uniform depressant action on the central nervous system, to a potentiation of γ-aminobutyric acid-mediated pre- and postsynaptic inhibition by enhancing inward γ-aminobutyric acidA Cl− currents, and by decreasing the release of excitatory transmitters glutamate and aspartate.5,6 Conversely, a potential mechanism for the proconvulsant properties of propofol may be due to intrinsic subcortical glycine antagonism as suggested by animal data.7 A systematic review demonstrated a predominance of seizure-like phenomena during induction, emergence, or delayed after anesthesia or sedation with only a few events during maintenance (when the level of anesthesia is relatively constant) in nonepileptic patients, indicating that seizure-like phenomena tend to occur during changes of blood and brain tissue levels of propofol.8 However, most of these events were classified as seizure-like phenomena of nonepileptic origin (events with an increased tone with twitching and rhythmic movements not perceived as generalized tonic-clonic seizures, opisthotonos, or involuntary movements). In patients with epilepsy, seizure-like phenomena of epileptic origin after propofol were very rare, and most often they occurred during recovery.8 It is also important to note that pro- and anticonvulsant mechanisms are modulated by the given dose of propofol as inhibitory central nervous system structures are more sensitive to depression than excitatory ones.9 In summary, there is increasing evidence from clinical studies demonstrating that propofol possesses anticonvulsant properties.1,6 Only in very rare circumstances is the administration of propofol associated with seizure-like phenomena, most commonly of nonepileptic origin.8 Sascha Meyer, MD Departments of Pediatric Intensive Care Medicine, Neonatology, and Neuropediatrics University Hospital of Saarland Homburg, Germany sascha.m[email protected] Ulrich Grundmann, MD Department of Anesthesiology and Intensive Care Medicine University Hospital of Saarland Homburg, Germany Britta Kegel, MD Ludwig Gortner, MD Ghiath Shamdeen, MD Departments of Pediatric Intensive Care Medicine, Neonatology, and Neuropediatrics University Hospital of Saarland Homburg, Germany