TRANSIENT FACIAL PALSY IN SPHENOIDAL ELECTRODE PLACEMENT

Purpose: Sphenoidal electrode (SE) insertion can cause pain, for which local anesthesia with lidocaine or intravenous administration of fent anyl has been advocated by different epilepsy treatment centers. Trans ient facial palsies have been observed after SE insertion. Their frequ ency of occurrence, distribution, and duration have not been well char acterized, however. We hypothesized that this complication is due to t he effect of local anesthesia on the peripheral branches of the sevent h cranial nerve. To test this hypothesis, we compared the incidence an d characteristics of facial palsy during SE insertions performed with either local anesthesia or after intravenous fentanyl administration. Methods: We performed a retrospective study in two patient groups. Gro up A consisted of 25 patients aged 28 +/- 8.2 years who underwent a pr olonged video-EEG (VEEG) monitoring study with SE after subcutaneous i nfusion of 1% lidocaine in the insertion area. Group B included 25 pat ients aged 30.1 +/- 8.9 years whose SE were inserted after intravenous administration of 100-200 mu g fentanyl. Blood pressure (BP) was moni tored every 3-5 min throughout the procedure. Results: Five patients ( 20%) from group A had a transient facial palsy; in 4, it was complete and in 1 it was partial; 1 patient had a bilateral facial palsy. Pares is lasted 1-7 min (mean 3.2 min). In all patients, the recovery was co mplete. None of the patients in group B had complications (p = 0.025, Fisher's exact test). Conclusions: Transient facial palsy is a relativ ely frequent complication of SE insertion when SE are placed under loc al anesthesia; patients should be forewarned of its possible occurrenc e.