Lateralized periodic discharges (LPDs) are a common electroencephalographic (EEG) pattern in the neurointensive care unit setting. LPDs are typically observed in association with acute structural lesions of the brain with different etiologies. There are no reports describing a link between the occurrence of LPDs and the administration of remifentanil. Remifentanil is a rapid-acting pure μ-opioid receptor agonist, which is indicated to provide analgesia and sedation in mechanically ventilated patients in intensive care units. We present a case of an 84-year-old man with neuroglycopenia who developed LPDs while sedated with remifentanil. We report, for the first time, a potential relationship between remifentanil and the induction of LPDs.
KaneNAcharyaJBenickzyS, et al. A revised glossary of terms most commonly used by clinical electroencephalographers and updated proposal for the report format of the EEG findings. Revision 2017. Clin Neurophysiol Pract. 2017;2:170-185.
McGuireGEl-BeheiryHManninenPLozanoAWennbergR. Activation of electrocorticographic activity with remifentanil and alfentanil during neurosurgical excision of epileptogenic focus. Br J Anaesth. 2003;91(5):651-655.
6.
WassCTGradyREFesslerAJ, et al. The effects of remifentanil on epileptiform discharges during intraoperative electrocorticography in patients undergoing epilepsy surgery. Epilepsia. 2001;42(10):1340-1344.
7.
KjaerTWHogenhavenHLeeAP, et al. Pharmacodynamics of remifentanil. Induced intracranial spike activity in mesial temporal lobe epilepsy. Epilepsy Res.2017;133:41-45.
8.
JanatiAChesserMZHusainMM. Periodic lateralized epileptiform discharges (PLEDs): a possible role for metabolic factors in pathogenesis. Clinical EEG. 1986;17(1):36-43.
9.
NeufeldMYVishnevskayaSTrevesTA, et al. Periodic lateralized epileptiform discharges (PLEDs) following stroke are associated with metabolic abnormalities. Electroencephalogr Clin Neurophysiol.1997;102(4):295-298.
10.
SchraederPLSinghN. Seizure disorders following periodic lateralized epileptiform discharges. Epilepsia. 1980;21(6):647-653.
11.
BatistaMSAlmeidaKJAvelinoMCBorgesLM. Hemiparesis and lateralized cortical lesions associated to severe hypoglycemia. Arq Neuropsiquiatr. 2008;66(1):101-103.
12.
GasparettoELBianchetLCDavausTde Carvalho NetoA. Intoxication with oral hypoglycemics as a cause of diffuse brain injury: case report. Arq Neuropsiquiatr. 2006;64(4):1036-1038.
13.
SigginsGRHenriksenSJChavkinCGruolD. Opioid peptides and epileptogenesis in the limbic system: cellular mechanisms. Adv Neurol. 1986;44:501-512.
14.
CobbWHillD. Electroencephalogram in subacute progressive encephalitis. Brain. 1950;73(3):392-404.
15.
Garcia-MoralesIGarciaMTGalan-DavilaL, et al. Periodic lateralized epileptiform discharges: etiology, clinical aspects, seizures, and evolution in 130 patients. J Clin Neurophysiol. 2002;19(2):172-177.
16.
SakataAMukaeNMoriokaT, et al. Simultaneous electroencephalographic and electocorticographic recordings of lateralized periodic discharges in temporal lobe epilepsy. Clin EEG Neurosci. 2020. doi:10.1177/1550059420972266
17.
Tjepkema-CloostermansMCHindriksRHofmeijerJvan PuttenMJ. Generalized periodic discharges after acute cerebral ischemia: reflection of selective synaptic failure?Clin Neurophysiol.2014;125(2):255-262.
18.
KalamangalamGPSlaterJD. Periodic lateralized epileptiform discharges and after discharges: common dynamic mechanisms. J Clin Neurophysiol. 2015;32(4):331-340.
19.
ChengJY. Metabolic encephalopathy vs seizures: distinguishing between triphasic waves and epileptiform discharges. Int J Neurol Dis. 2017;1(2):44-47.
20.
KayaDBingolCA. Significance of atypical triphasic waves for diagnosing nonconvulsive status epilepticus. Epilepsy Behav. 2007;11(4):567-577.
