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INTRODUCTION

Patients with known neurological conditions require special attention during the perioperative period. Sometimes, clinicians may newly diagnose neurological conditions during the perioperative period. In this chapter, we will focus on three neurological conditions: Seizure disorder, Parkinson’s disease, and Myasthenia gravis.

SEIZURE DISORDER

Epilepsy usually refers to a condition in which there is a risk of recurrent seizures related to a non transient chronic etiology. Seizure can be an isolated event with a transient precipitant. The term “convulsion” is no longer recommended. The 2017 International League Against Epilepsy Commission on Classification and Terminology classified seizure types into: (a) Focal onset with or without impaired awareness (the terms “partial,” “simple,” or “complex” seizures are no longer preferred), (b) generalized onset, and (c) unknown onset (for tonic-clonic or behavior arrest seizures where focal versus generalized onset is unknown).1

Myoclonus is a sudden brief muscle contraction(s) of one part of the body or the entire body. It is one of the more common involuntary movements noted in the perioperative period. They are colloquially referred to as “twitches” and sometimes “myoclonic jerks.” Patients with epilepsy may have myoclonic seizures. In the perioperative period, myoclonus may be triggered by hypoxia, hypercarbia, liver or kidney failure, medications (e.g., tramadol, quinolones, benzodiazepines, anticholinergics, gabapentin, opiates, propofol, etomidate), infection, or stroke.

Fasciculations, myoclonus, and waxing-waning delirium or consciousness may be observed in the intra- and postoperative period and be occasionally misclassified as a seizure. Sometimes patients with epilepsy may have a psychogenic non epileptic seizure in the postoperative period. Common triggers of seizure in the perioperative period are listed in Table 27-1.

TABLE 27-1Potential Triggers of Seizures in the Perioperative Period

Seizures can manifest in a variety of ways and it is important for perioperative physicians to have knowledge of the common manifestations of seizures if they were to witness or manage such an event. A few key considerations in managing patients with seizure disorders in the perioperative setting are shown in Figure 27-1.

FIGURE 27-1

Perioperative Considerations in the Management of Patients with Seizures.

Preoperative Considerations

In patients with a prior history of seizure disorder, detailed history should be obtained regarding the type of seizure, any known triggers, last seizure occurrence, home antiseizure drugs ...

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