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Recurrent seizure activity after epidural morphine in a post-partum woman

[Activité épileptique récurrente après une anesthésie péridurale avec morphinechez une femme en postpartum]

Chih-Jen Shih, MD^*, Anthony G. Doufas, MD PhD, Hsu-Chu Chang, MD^* and Chun-Ming Lin, MD^*

^* From the Department of Anesthesiology, Chang Gung Memorial Hospital, Tao Yuan, Taiwan; and
the Department of Anesthesiology and Perioperative Medicine and OUTCOMES RESEARCH^TM Institute, University of Louisville, Kentucky, USA.

Address correspondence to: Dr. Chun-Ming Lin, Department of Anesthesiology, Chang Gung Memorial Hospital, 5, Fu-Hsing St., Tao Yuan, Taiwan. E-mail: sam2498{at}adm.cgmh.org.tw. Reprints will not be available by the authors.

Purpose: We report on a primiparous woman who suffered recurrent seizure activity after repeated small doses of epidural morphine to highlight the neuroexcitation potential of neuraxial opioids in the epileptic patient.

Clinical features: Seizure activities as a complication of opioid administration have been reported in laboratory animals and humans. We report the case of a 30-yr-old primiparous woman with a history of epilepsy under carbamazepine treatment, who had epidural anesthesia for elective Cesarean section at 38 weeks gestation. Postoperatively, 1.5 mg of morphine were administered epidurally for pain control. Three hours later the patient suffered from clonic movements of the right arm without loss of consciousness. One day later, she again received 1 mg of epidural morphine twice at a 12-hr interval and similar seizure episodes recurred eight hours after each dose. A relation between the administration of morphine and seizure activity was suspected and the use of opioids for pain control was stopped. The patient was discharged on the fifth postoperative day and, more than one year after the last episode, she remains free of any seizure activity.

Conclusion: Our report indicates that even a remote history of epilepsy carries a pro-convulsant potential in the peripartum period, even following the administration of small doses of epidural morphine.