Can Propofol (propofol) induce seizures?

From the Guidelines

Propofol can rarely induce seizures, despite its primary anticonvulsant properties, and this risk should be considered in patients with epilepsy or neurological disorders. The mechanism behind propofol-induced seizures is thought to involve the inhibition of inhibitory cortical circuits and the activation of excitatory pathways at certain doses, leading to an imbalance between inhibition and excitation that can trigger abnormal electrical activity in the brain 1.

Clinical Presentation and Management

If a propofol-induced seizure occurs, the first step is to stop the propofol infusion immediately. Administering benzodiazepines such as midazolam (2-5mg IV) or lorazepam (2-4mg IV) can help control the seizure 1. Ensuring adequate oxygenation and ventilation is crucial, and considering phenytoin (15-20mg/kg IV) or levetiracetam (1000-3000mg IV) for persistent seizures may be necessary. Monitoring vital signs closely and being prepared to provide airway support if needed is also important.

Alternative Sedative Agents

After managing the acute event, considering alternative sedative agents for future procedures in affected patients, such as etomidate, ketamine, or dexmedetomidine, depending on the clinical context, may be beneficial. The use of prophylactic anticonvulsant drugs after cardiac arrest in adults has been insufficiently studied, and routine seizure prophylaxis in post-cardiac arrest patients is not recommended due to the risk of adverse effects and the poor response to anti-epileptic agents among patients with clinical and electrographic seizures 1.

Key Considerations

• Propofol's anticonvulsant properties do not eliminate the risk of seizures, especially in patients with a history of epilepsy or neurological disorders.
• The management of propofol-induced seizures involves stopping the infusion, administering benzodiazepines, and considering other antiepileptic drugs as needed.
• Alternative sedative agents should be considered for future procedures to minimize the risk of recurrent seizures.

From the FDA Drug Label

When propofol injectable emulsion is administered to an epileptic patient, there is a risk of seizure during the recovery phase. Perioperative myoclonia, rarely including convulsions and opisthotonos, has occurred in association with propofol injectable emulsion administration

Propofol and Seizure Risk: Yes, propofol can induce seizures, particularly in epileptic patients during the recovery phase. Additionally, perioperative myoclonia, including convulsions, has been reported in association with propofol administration 2.

From the Research

Propofol and Seizures

• Propofol is a sedative, anesthetic, and antiepileptic agent that can be used to control seizures, but it can also induce seizures or seizure-like phenomena in certain patients 3.
• The mechanism of propofol-induced seizures is not well understood, and it is still unclear whether the "seizure activity" is primarily, secondarily, or not at all a cerebral cortical event 3.
• Propofol infusion syndrome is a rare but serious complication of propofol administration, which can lead to metabolic disorder, acidosis, and cardiovascular collapse, and has been associated with seizures or seizure-like activity 4, 5.
• Some studies suggest that propofol can produce an involuntary movement disorder in certain patients, which can be mistaken for seizures 3.
• Seizure-like phenomena associated with propofol withdrawal may not be ictal in nature and should not lead to unnecessary resumption of propofol infusion without documentation of an epileptic origin by EEG 6.

Risk Factors and Complications

• The use of high doses of propofol for prolonged periods can increase the risk of propofol infusion syndrome and seizures 4, 5.
• Patients with a history of epilepsy or movement disorders may be at higher risk of developing seizures or seizure-like phenomena after propofol administration 3.
• The reporting of seizures possibly related to propofol should include a detailed medical history, description of the alleged seizure, and post-seizure investigations to determine the underlying cause 3.

Clinical Implications

• Propofol should be used with caution in patients with refractory status epilepticus, and close biochemical monitoring is needed to recognize propofol infusion syndrome promptly 4, 5.
• The diagnosis of seizures or seizure-like phenomena associated with propofol should be confirmed by EEG to rule out non-epileptic phenomena 6.
• Patients who experience apparent convulsive phenomena after propofol should not be re-exposed to the drug without careful consideration of the risks and benefits 3.