EPILEPSY AND SEIZURE DISORDERS

Preoperative evaluation:

Patients with pre-existing seizure disorders

• Patients may be at increased risk for seizures in the perioperative period due to infection, electrolyte and other metabolic disturbances.
• Patients may also be at risk because many anti-seizure medications can only be given PO (carbamazepine, gabapentin, lamotrigine, topiramate, among others).
• Plan ahead if NPO status is anticipated postop:
• Phenytoin (Dilantin) is commonly used antiepileptic medication for IV administration.  PO dose = IV dose.  Side effects include hypotension and arrhythmia when given IV.  (Must be given slowly IV).
• Phenobarbital, levetiracetam, and valproic acid are alternatives that may be given IV.
• Recommend discussion with pharmacy to convert from PO to IV phenobarbital or valproic acid.
• Recommend discussion with both pharmacy and neurology if a patient’s baseline medication needs to be switched to an alternative agent in IV form.

Postoperative management

Patients with pre-existing seizure disorders

• If unable to take enteral anti-epileptic medications, use IV forms (see above).  Work with pharmacy and Neurology as needed.

Patients with new onset seizures in the perioperative period

• Consider a broad differential diagnosis.
• Electrolyte abnormalities, especially Na+
• Medications e.g. meperidine, imipenem
• Infection
• Withdrawal, e.g. benzodiazepine or alcohol
• CNS injury
• Stroke
• Workup should include thorough history and physical, electrolytes, search for infection.  Other workup should be directed by clinical suspicion.
• Neurology consultation may be warranted depending on etiology.

 

Updated May 2011