Seizures, Intractable

Incidence in USA: 600,000 people with epilepsy have uncontrolled seizures.

Racial predominance: None.

Sudden death

Status epilepticus

Seizure-mediated cardiac dysrhythmias

Liver toxicity from anticonvulsants (on the decline with the new drug generation)

Periop trauma from convulsions

Sudden death

Status epilepticus postop

Altered pharmacologic responses due to chronic drug therapy

Neurologic disease associated with birth, congenital malformation, trauma, CNS pathology, idiopathic.

Periop risks for acquired seizure disorder are increased, but some epilepsy and/or congenital malformations carry their own anesthetic risks.

Check type of seizures, clinical manifestations, duration, and frequency.

Anticonvulsant therapy and side effects (liver function, level of consciousness).

Congenital (e.g., tuberous sclerosis and/or infantile seizure)

Idiopathic

CNS pathology: Trauma, tumor, hemorrhage