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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Occurrence of seizures in hospitalized patients with a pre-existing seizure disorder


Objective. To assess the frequency of seizures in hospitalized patients with a pre-existing seizure disorder.
Patients and Methods. A retrospective review was conducted on all patients with a documented seizure disorder who were hospitalized between January 1, 2002 and December 31, 2007. Children aged < 2 years and hospital admission for seizure control or surgical or obstetric indications were excluded. The first hospital admission of at least 24 hours was identified for each patient. Patient demographics, details of the seizure disorder, details of the hospital admission, and clinically-apparent seizure activity documented during the inpatient stay were recorded from the medical record.
Results. During the 6-year study period, 720 patients with a documented seizure disorder were admitted for at least 24 hours. Thirty-nine patients experienced seizure activity for an overall frequency  of 5.4% (95% CI: 3.8-7.1%). Younger age (p = 0.001), greater frequency of baseline seizure activity (p < 0.001), recent seizure activity (p < 0.001), greater number of chronic antiepileptic medications (p = 0.01), and admission for neurological (p = 0.03) conditions were associated with increased frequency of seizure activity during hospitalization.
Conclusions. The majority of seizures occurring in hospitalized patients with a pre-existing seizure disorder appear related to the patient’s underlying seizure disorder. Because patients with frequent seizures on numerous anti-epileptic medications are likely to experience a seizure while hospitalized, it is essential to be prepared to treat seizure activity regardless of the reason for admission.


Key words: seizure disorder, hospitalization, anticonvulsants

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Gabapentin for acute and chronic post-surgical pain


Pain after surgery remains a significant clinical problem as it impairs recovery adversely and may lead to the transition to chronic pain. Opioid medications are far from ideal agents in suppressing postoperative pain. Gabapentin -an anticonvulsant with antihyperalgesic properties- originally efficacious against neuropathic pain seems to be very promising for the management of pain after surgery as well. Gabapentin, by decreasing noxious stimulus-induced excitatory neurotransmitter release at the spinal cord, may attenuate central sensitization, and eventually decrease postoperative late pain. Furthermore, different sites of action may be pertinent to a synergistic effect with opioids. Both actions (antihyperalgesic effect and synergy with opioid analgesia) may manifest as analgesia and/or opioid-sparing effect after surgery. This has been confirmed by a variety of clinical studies, in a variety of settings. Most of these studies have shown that either single preoperative or repeated doses of gabapentin, continued for up to a few days after surgery, decrease acute postoperative pain and/or need for postoperative opioids. This has been shown for procedures such as abdominal and vaginal hysterectomy, breast surgery for cancer (mastectomy or lumpectomy), lumbar discectomy and spinal fusion, laparoscopic cholecystectomy and other, such as ENT surgery. Finally, a few studies indicate that perioperative gabapentin may as well decrease chronic pain several weeks after surgery.

Key Words: pain postoperative, pain chronic, post-mastectomy pain, anticonvulsants, gabapentin

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