A Case of an Elderly Patient with Dementia Who Had an Epileptiform Seizure during Dental Treatment under Intravenous Sedation

Abstract

We report a case in which an elderly patient with dementia who had a history of late-onset epileptic seizures was treated with intravenous sedation several times and had difficulty coping with postoperative epileptic seizures. This patient did not cooperate with dental treatment due to dementia, and so intravenous sedation was used in combination. Three of a total of nine intravenous sedation dental procedures resulted in epileptiform seizures. The first epileptiform seizure was noted upon emergence from anesthesia after the fourth dental treatment. Flumazenil-related withdrawal symptoms were suspected, so flumazenil was not used in the fifth dental treatment, and epileptiform seizures occurred while recovering from anesthesia. We suspected that the nerve excitatory effects of propofol might have induced epileptic seizures, and therefore anesthesia was managed without propofol from the sixth time onwards. The eighth dental treatment required 7mg of midazolam. Due to insufficient recovery from anesthesia, flumazenil was administered, resulting in epileptic seizures. The use of propofol and flumazenil in patients with epileptic seizures may trigger epileptic seizures.