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 journalReview article

13 Scopus citations

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
Publication statusPublished - Mar 24 2000

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Keywords

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

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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