Epilepsy Risk Associated With the Receipt of General Anesthesia Relative to Neuraxial Anesthesia: A Retrospective Cohort Study.

Summary

In over 177,000 adults undergoing procedures amenable to either general or neuraxial anesthesia, weighted analyses showed a time-dependent increase in new-onset epilepsy risk with general anesthesia compared with neuraxial techniques, becoming significant after ~3 years of follow-up.

Key Findings

• Weighted epilepsy incidence: 48.8 vs 35.5 per 100,000 person-years (general vs neuraxial).
• Time-varying effect: HR at time 0 was 0.61, but risk increased over time (time interaction HR 1.36), becoming significantly higher after ~3 years for general anesthesia.
• Robust methodology: IPTW adjustment and Fine–Gray competing risk modeling.

Clinical Implications

When feasible, neuraxial anesthesia may be preferred in patients concerned about long-term neurological risks; informed consent should acknowledge uncertainty and potential time-delayed risks after general anesthesia.

Limitations

• Residual confounding and unmeasured differences (e.g., surgical indications) may remain.
• Onset of new epilepsy risk factors during follow-up could not be fully controlled.

Future Directions

Procedure-specific analyses, prospective registries capturing perioperative brain insults, and mechanistic studies to disentangle anesthesia effects from surgical/pathology contributors.