Samra S K, Sneyd J R, Ross D A, Henry T R
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109-0048, USA.
Anesthesiology. 1995 Apr;82(4):843-51. doi: 10.1097/00000542-199504000-00005.
Case reports suggesting both pro- and anticonvulsant effect(s) of propofol have been published in recent years. The effects of sedative doses of propofol on epileptiform activities in patients suffering from intractable partial epilepsy were systematically investigated.
Fourteen patients suffering from complex partial seizures were studied. Electroencephalogram (EEG) was recorded from intracranial electrodes implanted in the hippocampi and temporal neocortex. Propofol was given as a computer-controlled infusion in four steps to achieve target plasma propofol concentrations of 0.3, 0.6, 0.9, and 1.2 micrograms/ml. Each concentration was maintained for 30 min, and steady-state kinetics were confirmed by blood levels drawn at 10th and 30th min at each level. Between the 15th and 30th min of each concentration of propofol, EEG was analyzed for presence of electroencephalographic seizure activity and/or number of interictal spikes (IIS). Effects of propofol on IIS frequency at different electrode sites were compared using a two-way repeated measures analysis of variance. A value of P < 0.05 was considered significant.
None of the patients developed a seizure during the 2 h of propofol infusion. No "false spikes" (spikes developing with propofol infusion in areas where no spikes were seen in baseline EEG) were seen. Although effects of propofol on IIS frequency were highly variable across patients and at different propofol doses in the same patient, there was no statistically significant effect of propofol on any electrode site with any of the doses studied.
We were unable to demonstrate a significant change in epileptiform activity with sedative doses of propofol in patients suffering from complex partial epilepsy.
近年来已发表了一些病例报告，提示丙泊酚具有抗惊厥和促惊厥作用。本研究系统地调查了镇静剂量的丙泊酚对难治性部分性癫痫患者癫痫样活动的影响。
对14例患有复杂部分性发作的患者进行研究。通过植入海马体和颞叶新皮质的颅内电极记录脑电图（EEG）。丙泊酚以计算机控制输注的方式分四个步骤给药，以达到目标血浆丙泊酚浓度为0.3、0.6、0.9和1.2微克/毫升。每个浓度维持30分钟，并通过在每个水平的第10分钟和第30分钟抽取的血药浓度确认达到稳态动力学。在丙泊酚每个浓度的第15分钟至30分钟之间，分析EEG以检测脑电图癫痫发作活动的存在和/或发作间期棘波（IIS）的数量。使用双向重复测量方差分析比较丙泊酚对不同电极部位IIS频率的影响。P值<0.05被认为具有统计学意义。
在丙泊酚输注的2小时内，没有患者发生癫痫发作。未观察到“假棘波”（在基线EEG中未见棘波的区域在丙泊酚输注时出现的棘波）。尽管丙泊酚对IIS频率的影响在患者之间以及同一患者的不同丙泊酚剂量下差异很大，但在所研究的任何剂量下，丙泊酚对任何电极部位均无统计学意义上的显著影响。
我们未能证明镇静剂量的丙泊酚对患有复杂部分性癫痫的患者的癫痫样活动有显著改变。
