Epilepsy and Anesthesia

Abstract

Epilepsy is one of the most common neurological conditions with the worldwide prevalence as high as 1%.1,2,3 Epilepsy can be classified into three categories: (1) generalized epilepsies, (2) focal epilepsies, and (3) a new group of combined generalized and focal epilepsies.8 Treatment of epilepsy begins with the initiation of an antiepileptic drug (AED). Patients who continue to seizure despite adequate therapy with two AEDs may require surgical interventions.1 There are many different surgical procedures that may be used in the management of epilepsy, including temporal lobectomy, extratemporal resections, hemispherectomy, vagal nerve stimulation (VNS), and deep brain stimulation (DBS). Epilepsy surgery often requires intraoperative localization of the epileptic focus. This can be achieved with intraoperative electrocorticography (ECoG). Many of our anesthetic drugs interfere with the intraoperative EEG recording, and a knowledge of their properties is required to provide a safe anesthetic. Anesthesia for epilepsy surgery can be done in one of three ways: (1) awake with local anesthesia, (2) general anesthesia, and (3) the asleep-awake-asleep technique. Complications including hemorrhage, venous air embolism, and status epilepticus may occur and require prompt treatment by the anesthesiologist. A thorough knowledge of neuroanesthesia is required to provide appropriate care to the epileptic patient. This review contains 3 figures, 4 tables, and 51 references. Keywords: Awake craniotomy, electrocorticography, epilepsy, neuroanesthesia, perioperative care, status epilepticus, treatment, temporal lobe surgery, intraoperative electrocorticography