Alfentanil-induced activation: A promising tool in the presurgical evaluation of temporal lobe epilepsy patients

Paulo César Ragazzo, Aristea S. Galanopoulou

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Pharmacologic activation of epileptic foci has been used experimentally with the hope that it may accelerate the presurgical evaluation of patients with medically intractable epilepsy. In this article, we will review the existing literature on these activating tests giving emphasis on the opioid analogs, and particularly alfentanil. Alfentanil is an opioid analog with rapid anesthetic effect, which has been known to trigger epileptiform discharges in epilepsy patients. 58 temporal lobe epilepsy (TLE) patients were studied with alfentanil activation during electrocorticography, at the Epilepsy Surgery Unit (ING, Brazil). An increase of the interictal epileptiform discharges was observed originating from hippocampal and parahippocampal regions (96.5%). To a lesser extent, alfentanil activated the basal and lateral temporal regions. Electrographic seizures were observed in 38%. In addition, we performed continuous video-EEG (VT/EEG) monitoring, with scalp and bilateral foramen ovale electrodes, in 12 TLE patients. The results of spontaneously observed seizures were compared with the electrographic changes following alfentanil activation (50-75 μg/kg, i.v.). In seven cases, alfentanil triggered focal electrographic seizures, ipsilaterally to the side generating the spontaneous seizures and in two patients it produced bilateral sequential activation of the temporal lobes. Ictal SPECTs during the alfentanil test showed hyperperfusion at the lateral temporal regions, ipsilaterally to the activated area or bilaterally. In summary, our study confirms the activating effect of alfentanil, and provides a strong evidence for its selective activating effect on the temporal lobes of TLE patients. The ictal SPECT during alfentanil activation did not offer any additional advantage for the localization of the ictal onset. (C) 2000 Elsevier Science B.V.

Original languageEnglish (US)
Pages (from-to)316-327
Number of pages12
JournalBrain Research Reviews
Volume32
Issue number1
DOIs
StatePublished - Mar 24 2000

Fingerprint

Alfentanil
Temporal Lobe Epilepsy
Temporal Lobe
Seizures
Stroke
Single-Photon Emission-Computed Tomography
Opioid Analgesics
Electroencephalography
Epilepsy
Foramen Ovale
Scalp
Brazil
Anesthetics
Electrodes

Keywords

  • Alfentanil
  • Electrographic seizure
  • Presurgical evaluation
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Alfentanil-induced activation : A promising tool in the presurgical evaluation of temporal lobe epilepsy patients. / Ragazzo, Paulo César; Galanopoulou, Aristea S.

In: Brain Research Reviews, Vol. 32, No. 1, 24.03.2000, p. 316-327.

Research output: Contribution to journalArticle

@article{6b0272c73561433da155f5ccd50c28d1,
title = "Alfentanil-induced activation: A promising tool in the presurgical evaluation of temporal lobe epilepsy patients",
abstract = "Pharmacologic activation of epileptic foci has been used experimentally with the hope that it may accelerate the presurgical evaluation of patients with medically intractable epilepsy. In this article, we will review the existing literature on these activating tests giving emphasis on the opioid analogs, and particularly alfentanil. Alfentanil is an opioid analog with rapid anesthetic effect, which has been known to trigger epileptiform discharges in epilepsy patients. 58 temporal lobe epilepsy (TLE) patients were studied with alfentanil activation during electrocorticography, at the Epilepsy Surgery Unit (ING, Brazil). An increase of the interictal epileptiform discharges was observed originating from hippocampal and parahippocampal regions (96.5{\%}). To a lesser extent, alfentanil activated the basal and lateral temporal regions. Electrographic seizures were observed in 38{\%}. In addition, we performed continuous video-EEG (VT/EEG) monitoring, with scalp and bilateral foramen ovale electrodes, in 12 TLE patients. The results of spontaneously observed seizures were compared with the electrographic changes following alfentanil activation (50-75 μg/kg, i.v.). In seven cases, alfentanil triggered focal electrographic seizures, ipsilaterally to the side generating the spontaneous seizures and in two patients it produced bilateral sequential activation of the temporal lobes. Ictal SPECTs during the alfentanil test showed hyperperfusion at the lateral temporal regions, ipsilaterally to the activated area or bilaterally. In summary, our study confirms the activating effect of alfentanil, and provides a strong evidence for its selective activating effect on the temporal lobes of TLE patients. The ictal SPECT during alfentanil activation did not offer any additional advantage for the localization of the ictal onset. (C) 2000 Elsevier Science B.V.",
keywords = "Alfentanil, Electrographic seizure, Presurgical evaluation, Temporal lobe epilepsy",
author = "Ragazzo, {Paulo C{\'e}sar} and Galanopoulou, {Aristea S.}",
year = "2000",
month = "3",
day = "24",
doi = "10.1016/S0165-0173(99)00098-3",
language = "English (US)",
volume = "32",
pages = "316--327",
journal = "Brain Research Reviews",
issn = "0165-0173",
publisher = "Elsevier",
number = "1",

}

TY - JOUR

T1 - Alfentanil-induced activation

T2 - A promising tool in the presurgical evaluation of temporal lobe epilepsy patients

AU - Ragazzo, Paulo César

AU - Galanopoulou, Aristea S.

PY - 2000/3/24

Y1 - 2000/3/24

N2 - Pharmacologic activation of epileptic foci has been used experimentally with the hope that it may accelerate the presurgical evaluation of patients with medically intractable epilepsy. In this article, we will review the existing literature on these activating tests giving emphasis on the opioid analogs, and particularly alfentanil. Alfentanil is an opioid analog with rapid anesthetic effect, which has been known to trigger epileptiform discharges in epilepsy patients. 58 temporal lobe epilepsy (TLE) patients were studied with alfentanil activation during electrocorticography, at the Epilepsy Surgery Unit (ING, Brazil). An increase of the interictal epileptiform discharges was observed originating from hippocampal and parahippocampal regions (96.5%). To a lesser extent, alfentanil activated the basal and lateral temporal regions. Electrographic seizures were observed in 38%. In addition, we performed continuous video-EEG (VT/EEG) monitoring, with scalp and bilateral foramen ovale electrodes, in 12 TLE patients. The results of spontaneously observed seizures were compared with the electrographic changes following alfentanil activation (50-75 μg/kg, i.v.). In seven cases, alfentanil triggered focal electrographic seizures, ipsilaterally to the side generating the spontaneous seizures and in two patients it produced bilateral sequential activation of the temporal lobes. Ictal SPECTs during the alfentanil test showed hyperperfusion at the lateral temporal regions, ipsilaterally to the activated area or bilaterally. In summary, our study confirms the activating effect of alfentanil, and provides a strong evidence for its selective activating effect on the temporal lobes of TLE patients. The ictal SPECT during alfentanil activation did not offer any additional advantage for the localization of the ictal onset. (C) 2000 Elsevier Science B.V.

AB - Pharmacologic activation of epileptic foci has been used experimentally with the hope that it may accelerate the presurgical evaluation of patients with medically intractable epilepsy. In this article, we will review the existing literature on these activating tests giving emphasis on the opioid analogs, and particularly alfentanil. Alfentanil is an opioid analog with rapid anesthetic effect, which has been known to trigger epileptiform discharges in epilepsy patients. 58 temporal lobe epilepsy (TLE) patients were studied with alfentanil activation during electrocorticography, at the Epilepsy Surgery Unit (ING, Brazil). An increase of the interictal epileptiform discharges was observed originating from hippocampal and parahippocampal regions (96.5%). To a lesser extent, alfentanil activated the basal and lateral temporal regions. Electrographic seizures were observed in 38%. In addition, we performed continuous video-EEG (VT/EEG) monitoring, with scalp and bilateral foramen ovale electrodes, in 12 TLE patients. The results of spontaneously observed seizures were compared with the electrographic changes following alfentanil activation (50-75 μg/kg, i.v.). In seven cases, alfentanil triggered focal electrographic seizures, ipsilaterally to the side generating the spontaneous seizures and in two patients it produced bilateral sequential activation of the temporal lobes. Ictal SPECTs during the alfentanil test showed hyperperfusion at the lateral temporal regions, ipsilaterally to the activated area or bilaterally. In summary, our study confirms the activating effect of alfentanil, and provides a strong evidence for its selective activating effect on the temporal lobes of TLE patients. The ictal SPECT during alfentanil activation did not offer any additional advantage for the localization of the ictal onset. (C) 2000 Elsevier Science B.V.

KW - Alfentanil

KW - Electrographic seizure

KW - Presurgical evaluation

KW - Temporal lobe epilepsy

UR - http://www.scopus.com/inward/record.url?scp=0034031187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034031187&partnerID=8YFLogxK

U2 - 10.1016/S0165-0173(99)00098-3

DO - 10.1016/S0165-0173(99)00098-3

M3 - Article

C2 - 10751680

AN - SCOPUS:0034031187

VL - 32

SP - 316

EP - 327

JO - Brain Research Reviews

JF - Brain Research Reviews

SN - 0165-0173

IS - 1

ER -