Jones Todd E, Cibula Jean E, Bohannon Don, Seubert Christoph N
From the Departments of Anesthesiology.
Neurology, University of Florida College of Medicine, Gainesville, Florida.
A A Pract. 2018 May 15;10(10):267-271. doi: 10.1213/XAA.0000000000000682.
Not everything that shakes is an epileptic seizure. We present a patient who repeatedly exhibited severe shaking at emergence from general anesthesia. Her nonepileptic myoclonus was mistaken for a refractory seizure and treated with benzodiazepines and intravenous anesthetics. The resulting depressed level of consciousness rendered myoclonus clinically indistinguishable from refractory seizures. Over the course of 6 procedures, we found that levetiracetam, a first-line antiepileptic drug, effectively suppressed her myoclonus. The episodic nature of perioperative anesthesia care presents a challenge for differentiating myoclonus from seizure while balancing the concerns raised by different surgical procedures, rare comorbidities, and the subjective patient experience.
并非所有的抖动都是癫痫发作。我们报告一位患者，她在全身麻醉苏醒时反复出现严重抖动。她的非癫痫性肌阵挛被误诊为难治性癫痫发作，并接受了苯二氮䓬类药物和静脉麻醉剂治疗。由此导致的意识水平下降使肌阵挛在临床上与难治性癫痫发作难以区分。在6次手术过程中，我们发现一线抗癫痫药物左乙拉西坦能有效抑制她的肌阵挛。围手术期麻醉护理的间歇性特点对区分肌阵挛和癫痫发作构成挑战，同时要平衡不同手术操作、罕见合并症以及患者主观体验所引发的问题。
