Anesthetic management with propofol in a patient with Rasmussen's encephalitis complicated by intractable partial-onset epileptic seizures: a case report

Abstract

Introduction: Rasmussen's encephalitis (RE) is a progressive and chronic ailment characterized by drug-resistant epileptic seizures. RE is uncommon, and no documented accounts of its anesthetic management exist. Anesthetic management without causing epileptic seizures is important in RE. Here, we present a case of safe anesthetic management in a pediatric patient with RE. Case presentation: A 7-year-old boy who was diagnosed with RE at the age of 6 years was scheduled for supernumerary tooth extraction under general anesthesia. The patient was being treated with prednisolone, sodium valproate, zonisamide, lacosamide, and famotidine. Despite receiving antiepileptic therapy, the patient experienced partial epileptic seizures several times per week. The seizures presented as numbness in his right hand and progressed to tonic-clonic seizures affecting the right side of his body. On the day of the surgical procedure, the patient was administered regular doses of antiepileptic drugs and prednisolone. Anesthesia was induced and maintained using a combination of propofol, remifentanil, and rocuronium. The surgical procedure was successfully performed, and the patient awakened smoothly from anesthesia. No epileptic seizures were observed intra- or post-operatively. Conclusion: RE typically presents with drug-resistant seizures and the initial symptoms are usually refractory partial seizures. Propofol is well-established as a treatment option for refractory status epilepticus, and it reduces the frequency of spikes in patients with partial epilepsy. In this case, general anesthesia without epileptic seizures was achieved using propofol.