New onset epilepsy following unintentional durotomy in a patient on anti-psychiatric medication

• Published in: Journal of surgical case reports Vol. 2010; no. 2; p. 3
• Main Authors: West, M, Prasad, PSV, Ampat, G
• Format: Journal Article
• Language: English
• Published: England JSCR Publishing Ltd 01-04-2010; Oxford University Press
• Subjects: Antipsychotic drugs; Case studies; Causes of; Complications; Complications and side effects; Dura mater; durotomy; epilespy; Injuries; lumbar discectomy; Neurosurgery; Risk factors; Seizures (Medicine); Spine; Surgery; tonic clonic; United Kingdom
• ISSN: 2042-8812; 2042-8812
• DOI: 10.1093/jscr/2010.2.3

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural tears during surgery and CSF hypovolaemia are thought to be the main contributing factors, one postulates on the effects of anti-psychiatric medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases where the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible epileptogenic medication.