Effects of Propofol on Electrocorticography in Patients With Intractable Partial Epilepsy

Background Propofol's potential to trigger generalized tonic-clonic seizures and epileptic discharges is still controversial. The aim of this study was to investigate the incidence of epileptic discharges and epileptic seizures in epilepsy patients anesthetized with propofol. Methods Thirty three patients with intractable partial epilepsy selected for video electrocorticography-monitoring were studied. Twenty-three of them had epilepsy surgery with at least one year of followup. Subdural electrodes were surgically removed under propofol anesthesia. Video electrocorticography recordings were classified into two phases (Phase-A, ≥2 min without propofol, followed by Phase-P, starting 20 s after propofol injection) and visually analyzed concerning the occurrence of spikes, and spike-burst-suppression-patterns. Results No seizures were detected. Spikes were recorded in Phase-P, but without a significant change in frequency compared to Phase-A. Spike-burst-suppression-patterns occurred in 8 of the 33 patients (24.2%). Five of those patients (62.5%) had epilepsy surgery, 3 (60%) became seizure-free. Conclusions Our results do not contraindicate the use of propofol in patients with partial epilepsy. While spike-burst-suppression-patterns were recorded under propofol, the small number of surgically treated patients limits conclusions concerning their predictive value for improved epilepsy surgery outcome.