thiopental and Epilepsy--Tonic-Clonic

Depression is a common mental disorder. It affects millions of people worldwide and is considered by the World Health Organization (WHO) to be one of the leading causes of disability. Electroconvulsive therapy (ECT) is a well-established treatment for severe depression. Intravenous anaesthetic medication is used to minimize subjective unpleasantness and adverse side effects of the induced tonic-clonic seizure. The influence of different anaesthetic medications on the successful reduction of depressive symptoms and adverse effects is unclear.. This review evaluated the effects of different regimens of intravenous sedatives and hypnotics on anti-depression efficacy, recovery and seizure duration in depressed adults undergoing ECT.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12); MEDLINE via Ovid SP (from 1966 to 31 December 2012); and EMBASE via Ovid SP (from 1966 to 31 December 2012). We handsearched related journals and applied no language restrictions.. We included randomized controlled trials (RCTs) and cross-over trials evaluating the effects of different intravenous sedatives and hypnotics for ECT. We excluded studies and trials using placebo or inhalational anaesthetics and studies that used no anaesthetic.. Two review authors independently assessed trial quality and extracted data. When possible, data were pooled and risk ratios (RRs) and mean differences (MDs), each with 95% confidence intervals (CIs), were computed using the Cochrane Review Manager statistical package (RevMan).. We included in the review 18 RCTs (599 participants; published between 1994 and 2012). Most of the included trials were at high risk of bias.We analysed the results of studies comparing six different intravenous anaesthetics.Only a few studies comparing propofol with methohexital (four studies) and with thiopental (three studies) could be pooled.No difference was noted in the reduction of depression scores observed in participants treated with propofol compared with methohexital (low-quality evidence). These four studies were not designed to detect differences in depression scores.The duration of electroencephalograph (EEG) and of motor seizures was shorter in the propofol group compared with the methohexital group (low-quality evidence). No difference was seen in EEG seizure duration when propofol was compared with thiopental (low-quality evidence).Time to recovery (following commands) was longer among participants after anaesthesia with thiopental compared with propofol (low-quality evidence).For the remaining comparisons of anaesthetics, only single studies or insufficient data were available. Adverse events were inadequately reported in eligible trials, and none of the included trials reported anaesthesia-related mortality.. Most of the included studies were at high risk of bias, and the quality of evidence was generally low. The studies were not designed to detect clinically relevant differences in depression scores. Anaesthetic agents should be chosen on the basis of adverse effect profile, emergence and how these medications affect seizure duration. If it is difficult to elicit an adequately long seizure, methohexital may be superior to propofol (low-quality evidence). If a patient is slow to recover from anaesthesia, propofol may allow a faster time to follow commands than thiopental (low-quality evidence). A factor of clinical concern that was not addressed by any study was adrenal suppression from etomidate. Optimal dosages of intravenous sedatives or hypnotics have not yet been determined.Larger well-designed randomized studies are needed to determine which intravenous anaesthetic medication leads to the greatest improvement in depression scores with minimal adverse effects.

Topics: Adult; Anesthetics, Intravenous; Depression; Electroconvulsive Therapy; Epilepsy, Tonic-Clonic; Etomidate; Humans; Hypnotics and Sedatives; Methohexital; Midazolam; Propofol; Randomized Controlled Trials as Topic; Thiamylal; Thiopental

It is now clear that "seizure activity", excitatory phenomena, and/or a disorder of muscle tone are potential complications of the use of propofol. Whether this "seizure activity" is primarily, secondarily, or not at all a cerebral cortical event is still to be elucidated. Clearly propofol does have anticonvulsant activity, and also clearly it can produce an involuntary movement disorder, in certain patients, under certain conditions. Propofol is not the first anaesthetic drug to be implicated in the causation of seizures or abnormal movements nor indeed the first to appear to have anti-convulsant and proconvulsant activity (e.g. Althesin). While propofol has undoubtedly proved a very useful drug, the problem of convulsive phenomena creates a degree of background concern about its use. More needs to be known about the mechanism of this complication and any risk factors involved in determining who may have a seizure after propofol. In the clinical setting, the reporting of seizures possibly related to propofol should include--medical history, including personal or family history of epilepsy and movement disorders; a history of previous anaesthetics and whether propofol was used; regular medications; use of drugs or alcohol; history of chemical dependency; emotional state prior to induction; presence of hyperventilation or fever; a description of the alleged seizure, including rate of administration of propofol and amount given, time of onset of seizure in relation to time of drug administration, speed of onset of signs, quality of the abnormal movements, part of body involved, duration, any indication of a postictal state, any cardiovascular changes which may have accompanied the seizure, and any other possible triggers for the reaction such as other drugs used, including premedication; post seizure investigations including temperature, blood sugar, electrolytes, arterial gas analysis, neurological examination, EEG and CT scan. These actions and these investigations concerning propofol should not be delayed. It would appear appropriate to recommend to patients who experience apparent convulsive phenomena after propofol that they not be re-exposed to the drug.

Topics: Adult; Anesthesia, Intravenous; Epilepsy, Tonic-Clonic; Female; Humans; Male; Middle Aged; Phenytoin; Propofol; Seizures; Thiopental

Posterior reversible encephalopathy syndrome refers to a neuroradiologic disorder in which seizure activity (multiple seizures are more common than single events) is commonly the initial presenting symptom. We describe a case of posterior reversible encephalopathy syndrome in a previously healthy parturient who presented to the labor and delivery suite with generalized tonic-clonic seizures. Prompt recognition and treatment of this potentially catastrophic disease may avert injury to the patient and neonate.

Topics: Adolescent; Anesthetics, Intravenous; Anticonvulsants; Brain; Cesarean Section; Epilepsy, Tonic-Clonic; Factor V; Female; Humans; Hypertension; Intubation, Intratracheal; Magnesium Sulfate; Magnetic Resonance Imaging; Neuromuscular Depolarizing Agents; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Succinylcholine; Syndrome; Tachycardia; Thiopental; Tomography, X-Ray Computed

We describe a patient who entered a stuporous state after receiving benzodiazepine treatment for generalized tonic-clonic status epilepticus. A diagnosis of generalized NCSE with tonic seizures was made on the basis of the clinical picture and response to barbiturate anaesthetic, although the EEG pattern was not typical of the changes previously described in tonic seizures-tonic status epilepticus. This report discusses the differential diagnosis of postictal stupor, nonconvulsive status epilepticus with tonic seizures and sedation caused by the emergency treatment of status epilepticus, and summarizes the literature on tonic seizures and tonic status epilepticus.

Topics: Adult; Anticonvulsants; Benzodiazepines; Coma; Diagnosis, Differential; Electroencephalography; Epilepsy, Complex Partial; Epilepsy, Generalized; Epilepsy, Tonic-Clonic; Female; Humans; Learning Disabilities; Phenobarbital; Seizures; Status Epilepticus; Thiopental; Valproic Acid

Topics: Abnormalities, Multiple; Anticonvulsants; Apnea; Child; Chromosome Deletion; Chromosomes, Human, Pair 4; Craniofacial Abnormalities; Diazepam; Dose-Response Relationship, Drug; Drug Therapy, Combination; Emergency Medical Services; Epilepsy, Tonic-Clonic; Female; Humans; Infusions, Intravenous; Phenobarbital; Status Epilepticus; Syndrome; Thiopental; Valproic Acid

Topics: Anesthesia, General; Anesthetics, General; Apnea; Bradycardia; Epilepsy, Generalized; Epilepsy, Tonic-Clonic; Hernia, Inguinal; Humans; Hyponatremia; Infant, Newborn; Isoflurane; Male; Seizures; Thiopental

Topics: Ambulatory Surgical Procedures; Anesthesia, Dental; Anesthesia, General; Child; Epilepsy, Tonic-Clonic; Female; Humans; Propofol; Thiopental

Topics: Adolescent; Adult; Aged; Brain Injuries; Coma; Epilepsy, Tonic-Clonic; Humans; Hypoxia, Brain; Middle Aged; Neurosurgery; Postoperative Complications; Thiopental