Muscle relaxants

None of the muscle relaxants used in clinical anesthesia has been reported to cause epileptiform activity or seizures, nor have anticonvulsant properties been reported in humans. Accumulation of laudanosine, a metabolite of atracurium, may slightly decrease the seizure threshold.95

Resistance to metocurine96 and atracurium or vecuronium-induced97 neuromuscular blockade has been demonstrated in patients who chronically receive phenytoin. Patients treated with chronic anticonvulsant therapy recovered from pipecuronium more rapidly than nonmedicated patients. Furthermore, there seems to be a dose-effect relationship between the number of anticonvulsants received and a decreased time to recovery from pipecuronium neuromuscular blockade.98

Anticholinesterases

Anticholinesterases used in clinical anesthetic practice have not been reported to cause or stop seizures.

Anticholinergics

Atropine can reduce abnormal discharges on the EEGs of patients with epilepsy.99 It can also block spontaneous and hyperventilation-induced absence seizures.100 These effects are probably related to its central anticholinergic action.

Adapted from: Najjar S, Devinsky O, Rosenberg AD, et al. Procedures in epilepsy patients. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;499–513.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised April 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.