Induction of partial epileptic seizures by flumazenil.
OBJECTIVE
This study addressed the efficacy of flumazenil (FMZ) to induce or activate interictal or ictal epileptic discharges in patients with medically intractable partial epilepsies.


METHODS
Flumazenil, 1 mg, was injected intravenously in 67 patients undergoing presurgical monitoring for epilepsy surgery, 49 of whom had been treated with benzodiazepines (BZDs) before flumazenil was given. Continuous video electroencephalogram (EEG) monitoring with surface or intracranial electrodes was used to evaluate interictal EEG activity, ictal discharges, and the occurrence and semiology of clinically manifest epileptic seizures.


RESULTS
Interictal epileptiform potentials did not change in frequency or distribution after FMZ. In patients not pretreated with BZDs, epileptic seizures could not be provoked. In eight of the 49 patients pretreated with BZDs, epileptic seizures occurred within 30 min of FMZ application. Seizure semiology and regional EEG onset were identical to seizures recorded without FMZ. Patients operated on according to seizure-onset localization with FMZ had a >75% reduction in seizure frequency or became seizure free.


CONCLUSIONS
Seizure induction by FMZ seems to be a valid method for evaluating seizure semiology and localization of the seizure-onset zone during presurgical monitoring of patients with medically intractable localization-related epilepsies.
Schulze-Bonhage
A
A
Clinic of Epileptology, University of Bonn, Germany.
Elger
C E
CE
D000927:Anticonvulsants / Q000037:antagonists & inhibitors* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001569:Benzodiazepines / Q000037:antagonists & inhibitors* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000187:drug effects / Q000706:statistics & numerical data*; D004828:Epilepsies, Partial / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D005442:Flumazenil / Q000008:administration & dosage / Q000494:pharmacology; D058787:GABA-A Receptor Antagonists; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D011963:Receptors, GABA-A / Q000187:drug effects / Q000378:metabolism; D012189:Retrospective Studies; D014743:Videotape Recording
D000927:Anticonvulsants; D058787:GABA-A Receptor Antagonists; D011963:Receptors, GABA-A; D001569:Benzodiazepines; D005442:Flumazenil