A case report of several intraoperative convulsions while using the Narcotrend monitor: Significance and predictive use

Joana Berger-Estilita, Katharina Steck, Christian Vetter, Kathleen Seidel, Vladimir Krejci, Darren Hight, Heiko Kaiser, Joana Berger-Estilita, Katharina Steck, Christian Vetter, Kathleen Seidel, Vladimir Krejci, Darren Hight, Heiko Kaiser

Abstract

Introduction: Intraoperative seizures under general anesthesia are rare and our observation is the first to demonstrate a distinct electroencephalogram (EEG) pattern on the Narcotrend monitor.

Patient concerns: We present the case of a 30-year-old man undergoing craniotomy for glioblastoma resection under general anesthesia who suffered tonic-clonic seizures captured in a specific pattern by the intraoperative EEG.

Diagnoses: Our depth of anesthesia monitor recorded, before the seizure, a widening of the beta-wave performance in a distinct "triangular-shaped" pattern. This pattern was repeated before the second seizure. The patient had no previous history of seizures and following surgery no further seizures were recorded.

Interventions: A spectrogram analysis showed a distinct increase in mean absolute beta power immediately prior to the first seizure. The EEG immediately prior to the second seizure was characterized by broadband noise. Both seizures were characterized by increased mean absolute delta, theta, and beta power.

Outcomes: The increase in EEG beta activity seen before the tonic-clonic movements may represent cortical irritability secondary to surgical manipulation, induced by electrical stimulation, reflecting progressive brain over-arousal. The attentive analysis of the relative beta power may have helped forecast the occurrence of the second seizure.

Lessons: We report the use of a simple, inexpensive, and portable EEG-based monitoring device to assist seizure detection and decision making.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Legend: Evolution of the seizures. A shows the density spectral array (as depicted by a Narcotrend monitor). B shows the spectral relative power (in %) over time. C shows the mean power of main electroencephalographic (EEG) frequencies (analyzed with Matlab). The red arrows in A mark the occurrence of the first and second seizure, respectively. Before each seizure there is a progressive increase of relative power in the beta frequency band, indicated by the triangular shape pattern (A). Before both seizures there is a progressive increase of power in the beta-wave range (C). Before the second seizure the slope/increase of beta power is reduced under higher levels of propofol and dexmedetomidine.

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Source: PubMed

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