title: Transient and reproducible loss of motor-evoked potential signals after intravenous levetiracetam in a child undergoing craniotomy for resection of astrocytoma.
abstract: Transcranial electrical motor-evoked potential (tceMEP) monitoring is used in complex intracranial and spinal surgeries to detect and prevent neurological injury. We present a case of transient, reproducible loss of tceMEPs after an infusion of levetiracetam during craniotomy and tumor resection in a child. Cessation of the infusion resulted in restoration of baseline tceMEPs. When the infusion was resumed at the end of the procedure, a similar decrease in tceMEPs was seen as before, after the infusion was stopped. The surgery and postoperative course proceeded without incident, and the patient experienced a full recovery.
authors.affiliation: From the *Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; †Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Pennsylvania; ‡Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania; §Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania; and ‖Medtronic International, Tolochenaz, Switzerland.
authors.forename: Allan F
authors.initials: AF
authors.lastname: Simpao
authors.forename: Luke S
authors.initials: LS
authors.lastname: Janik
authors.forename: Grace
authors.initials: G
authors.lastname: Hsu
authors.forename: Alan Jay
authors.initials: AJ
authors.lastname: Schwartz
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Heuer
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Warrington
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Rehman
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D001254:Astrocytoma / Q000601:surgery*; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003399:Craniotomy; D019054:Evoked Potentials, Motor / Q000187:drug effects*; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D000077287:Levetiracetam; D016343:Monitoring, Intraoperative / Q000379:methods; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam