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Data on seizure-like phenomena (SLP) in patients receiving propofol were systematically reviewed. Reports had to provide detailed information on SLP in individual patients who received propofol. Phenomena were classified according to the t ime point of their occurrence during anesthesia or sedation (induction, maintenance, emergence, delayed [>30 minutes after emergence]) and their clinical presentation (generalized tonic-clonic seizures, focal motor seizures, events presented as increased tone with twitching and rhythmic movements not perceived as generalized tonic-clonic seizures, opisthotonos, involuntary movements). In 70 patients without epilepsy, SLP happened during induction in 24 (34%), during maintenance in two (3%), during emerge nce in 28 (40%), and was delayed in 16 (23%). Most frequent clinical presentations of SLP were generalized tonic-clonic seizures in 30 patients (43%), events presented as increased tone with twitching and rhythmic movements not perceived as generalized t onic-clonic seizures in 20 (36%), and involuntary movements in 11 (16%). Of 11 patients with epilepsy, seven (64%) had generalized tonic-clonic seizure during emergence. Of all 81 patients, 26 (32%) only had an EEG, and 12 (15%) only a neurologic consul tation. SLP may happen in patients with or without epilepsy receiving propofol. The time point of the occurrence of SLP suggests that a change in cerebral concentration of propofol may be causal. To confirm this hypothesis, to estimate the prevalence o f propofol-related SLP, and to identify patients at risk, data of higher quality are needed. |
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