Propofol-induced dystonia: A case report and a review of the literature

Purpose: To report a case of acute dystonia that appears related to the use of propofol in a patient with epilepsy and to report its successful management by diphenhydramine. Clinical features: A 16-year-old white male with a history of left posterior temporal neocortical onset seizures underwent epilepsy surgery. Preoperative antiepileptic maintenance medications included phenytoin and lamictal. A limited posterior temporal resection (topectomy) was performed, and propofol (Diprivan(R)) was used to supplement the local anesthesia. During the surgery the patient developed prominent orofacial and extremity dystonia with forced, maximal mouth opening during speech and leg jerking. The movements were associated with agitation and confusion. Following surgery administration of intravenous fos-phenytoin resulted in an exacerbation of the movement disorder. The patient responded favorably to intravenous diphenhydramine therapy; the involuntary movements and confusion abated completely over a 3-hour period. The reaction was classified as moderate in severity, possible in probability and nonpreventable. Conclusion: Propofol therapy has the potential to induce dystonia that can be controlled by diphenhydramine. The risk of dystonia may be increased in individuals also receiving phenytoin.