Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF

Case study and review article: epilepsy-like movements induced by fentanyl analgesia

The Egyptian Journal of Internal Medicine volume 29, pages 86–90 (2017)Cite this article

Abstract

Epilepsy-like movements are observed immediately after the administration of fentanyl as well as its derivatives. Although the event has no serious outcomes, it is so worrisome that it has garnered the attention of many authors to publish case reports of such events. Despite the presence of cerebral lesions in some cases, epileptic focus cannot be attributed to such lesions. Radiological and electrophysiological studies have failed to reveal abnormal cerebral activity during such events. The reported activity is usually generalized tonic–clonic convulsions. Epileptic convulsive movements were observed with low doses of fentanyl and its derivatives. Previous studies on animals have supported the occurrence of such epileptiform movements in corresponding doses. Idiosyncrasy and narcotic-related muscle rigidity did not satisfactorily explain the seizures. Our case report represents the occurrence of epileptiform movements twice in and an old patient with no cerebral insult. The past history was epileptic activity under control with lamotrigine for last 2 years.

References

  1. Bowdle T, Rooke G. Postoperative myoclonus and rigidity after anesthesia with opioids. Anesth Analg 1994; 78:783–786.

    Article  CAS  Google Scholar 

  2. Hsieh X, Hsu Y, Cherng C, Lin C, Huang G, Lin S, et al. Grand mal seizure induced by low-dose fentanyl and lidocaine in a young child. Acta Anaesthesiol Taiwan 2015; 53:105–108.

    Article  Google Scholar 

  3. Katz R, Eide T, Hartman A, Poppers P. Two instances of seizure-like activity in the same patient associated with two different narcotics. Anesth Analg 1988; 67:289–290.

    CAS  PubMed  Google Scholar 

  4. Henderson F, May W, Gruber DJ, Puskovic Y, Young A. Role of central and peripheral opiate receptors in the effects of fentanyl on analgesia, ventilation and arterial blood-gas chemistry in conscious rats. Respir Physiol Neurobiol 2014; 191:95–105.

    Article  CAS  Google Scholar 

  5. Barash P, Cullen B, Stoelting R. Clinical anesthesia. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.

  6. Barr J, Fraser G, Gilles L, Puntillo K, Ely W, Gélinas C, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263–306.

    Article  Google Scholar 

  7. Liu L, Gropper M. Postoperative analgesia and sedation in the adult intensive care unit. Drugs 2003; 63:755–767.

    Article  CAS  Google Scholar 

  8. Medscape. Sublimaze (fentanyl) dosing, indications, interactions, adverse effects, and more; 2016. Available at: http://reference.medscape.com/drug/sublimaze-fentanyl-343311#0/drug/sublimaze-fentanyl-343311#0. [Accessed 31 October 2016].

  9. US Food and Drug Administration. Opioid pain or cough medicines combined with benzodiazepines: drug safety communication—FDA requiring boxed warning about serious risks and death; 2016. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm518710.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm518710.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. [Accessed 31 October 2016].

  10. Sessler C, Varney K. Patient-focused sedation and analgesia in the ICU. Chest 2008; 133:552–565.

    Article  CAS  Google Scholar 

  11. Saarenmaa E, Neuvonen P, Fellman V. Gestational age and birth weight effects on plasma clearance of fentanyl in newborn infants. J Pediatr 2000; 136:0767–0770.

    Article  CAS  Google Scholar 

  12. Safwat A, Daniel D. Grand mal seizure after fentanyl administration. Anesthesiology 1983; 59:78.

    Article  CAS  Google Scholar 

  13. Brian J, Seifen A. Tonic-clonic activity after sufentanil. Anesth Analg 1987; 66:481.

    Article  Google Scholar 

  14. Haber G, Litman R. Generalized tonic-clonic activity after remifentanil administration. Anesth Analg 2001; 93:1532–1533.

    Article  CAS  Google Scholar 

  15. Hsieh X, Hsu Y, Cherng C, Lin C, Huang G, Lin S. Grand mal seizure induced by low-dose fentanyl and lidocaine in a young child. Acta Anaesthesiol Taiwan 2015; 53:105–108.

    Article  Google Scholar 

  16. Scott JF. Seizure-like movements during afentanyl infusion with absence of seizure activity in a simulataneous EEG recording. Anesthesiology 1985; 62:812–813.

    Article  CAS  Google Scholar 

  17. Fujimoto T, Nishiyama T, Hanaoka K. Seizure induced by a small dose of fentanyl. J Anesth 2003; 17:55–56.

    Article  Google Scholar 

  18. Borghs S, Thieffry S, Noack-Rink M, Dedeken P, Hong L, Byram L, et al. Health care cost associated with the use of enzyme-inducing and non-enzyme-active antiepileptic drugs in the UK: a long-term retrospective matched cohort study. BMC Neurol 2017; 17:1.

    Article  Google Scholar 

  19. Scott J, Sarnquist F. Seizure-like movements during a fentanyl infusion with absence of seizure activity in a simulataneous EEG recording. Anesthesiology 1985; 62:812–813.

    Article  CAS  Google Scholar 

  20. Larson K, Wittwer E, Nicholson W, Weingarten T, Price D, Sprung J. Myoclonus in patient on fluoxetine after receiving fentanyl and low-dose methylene blue during sentinel lymph node biopsy. J Clin Anesth 2015; 27:247–251.

    Article  Google Scholar 

  21. Richardson S, Egan T. The safety of remifentanil by bolus injection. Expert Opin Drug Saf 2005; 4:643–651.

    Article  CAS  Google Scholar 

  22. Modica P, Tempelhoff R, White P. Pro- and anticonvulsant effects of anesthetics (part I). Anesth Analg 1990; 70:303–315.

    Article  CAS  Google Scholar 

  23. Patsalos P, Perucca E. Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs. Lancet Neurol 2003; 2:473–481.

    Article  CAS  Google Scholar 

  24. Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol 2006; 61:246–255.

    Article  CAS  Google Scholar 

  25. Szaflarski J, Linda Steinbaugh MD. Adjunctive therapy for the treatment of primary generalized tonic–clonic seizures: focus on once-daily lamotrigine. Drug Des Devel Ther 2010; 4:337–342.

    Article  Google Scholar 

  26. Medscape. Sublimaze (fentanyl) dosing, indications, interactions, adverse effects, and more; 2017. Available at: http://reference.medscape.com/drug/sublimaze-fentanyl-343311#4/drug/sublimaze-fentanyl-343311#4. [Last accessed 2010].

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull HU3 2JZ, Hull, UK

    Mahmoud El-Karamany MRCPI, MD

Authors
  1. Mahmoud El-Karamany MRCPI, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mahmoud El-Karamany MRCPI, MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El-Karamany, M. Case study and review article: epilepsy-like movements induced by fentanyl analgesia. Egypt J Intern Med 29, 86–90 (2017). https://doi.org/10.4103/ejim.ejim_17_17

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_17_17

Keywords