During induction with propofol, spontaneous movements can occur without associated epileptiform abnormalities. These movements may include:

  • dystonia
  • chorea
  • athetosis
  • twitches
  • opisthotonus

Abnormal movements may mimic tonic and clonic movements during seizures, especially during the postoperative period.76 In several cases, cortical epilepsy was activated during electrocorticography, with epileptiform activity beginning 20–30 seconds after a bolus of intravenous propofol.77 Seizures may recur for 7 to 23 days after propofol anesthesia, suggesting a proconvulsant metabolite.78,79

Propofol also has anticonvulsant properties in animals80 and humans.81 Continuous propofol infusion can terminate status epilepticus refractory to other therapies.82

In epilepsy patients who underwent dental procedures, administration of propofol in subanesthetic doses to achieve conscious sedation did not provoke seizures or enhance any interictal epileptiform activity.45

One study showed that administration of calcium chloride minimizes the hemodynamic effects of propofol in patients who undergo coronary artery bypass grafting, and thereafter it may potentially reduce postoperative epileptic paroxysms in these patients.9 Recent studies indicate that the synergetic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting reduces hemodynamic impairment, which is implicated in the pathogenesis of postoperative seizures.83

Adapted from: Najjar S, Devinsky O, Rosenberg AD, et al. Procedures in epilepsy patients. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;499–513. With permission from Elsevier (www.elsevier.com).

Authored By: 
Orrin Devinsky MD
Souhel Najjar MD
Andrew D Rosenberg MD
Reviewed By: 
Steven C. Schachter MD
Thursday, April 1, 2004