At Kliniek het Bolwerk we carry out eyelid corrections under local anaesthetic. For most people this is a safe and comfortable way of anaesthetising. Do you have epilepsy? Then it is important to always report this, because local anaesthetic can in rare cases affect the excitability of the brain.
In this blog we explain what is known about local anaesthesia and epilepsy, and how we deal with this at Kliniek het Bolwerk.
What is the connection between local anaesthetic and epilepsy?
Local anaesthetics, such as lidocaine, are widely used and are generally very safe. Even so, it is known that people with epilepsy may have an increased susceptibility to having an epileptic seizure as a side effect of local anaesthetics [1].
This risk has mainly been described with high doses or rapid absorption of the agent into the bloodstream (local anaesthetic systemic toxicity, LAST). Cases have also been described of people who had been seizure-free for years and still had an epileptic seizure after receiving local anaesthetic [2].
With eyelid surgery however, a very small amount of local anaesthetic is used, administered locally into the skin of the eyelid. This is a different situation from large amounts of local anaesthesia, for example during a dental procedure or a nerve block.
Points of attention
- Epilepsy is a point of attention, not an automatic contraindication for local anaesthetic [1]
- The risk is greater with high doses of local anaesthetics, less with the small amounts that are used with an eyelid correction
- Continuing anti-epileptic medication around the procedure is important for maintaining seizure control [3]
- Stress, fatigue and sleep deprivation around a procedure can in themselves also be a trigger for a seizure, apart from the anaesthetic [4]. So make sure that you are well rested before the treatment and ensure sufficient moments of rest after the treatment.
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Our protocol at Kliniek het Bolwerk
1. Extensive medical history
We ask about the type of epilepsy, how long you have been seizure-free, which medication you use and whether there are known triggers.
2. Continuing medication
Anti-epileptics are simply continued according to the normal schedule, on the day of the procedure too [3].
3. Minimal, measured anaesthetic
We use the smallest possible amount of local anaesthetic needed for a comfortable procedure, with attention to gradual administration.
4. Calm environment and planning
We take account of sufficient rest prior to the procedure and plan the appointment at a moment that suits your daily rhythm, to limit unnecessary stress or fatigue [4].
Important: epilepsy is in most cases not a contraindication for an eyelid correction under local anaesthetic, provided this is reported beforehand and the seizure control is stable. If in doubt, we consult with your neurologist.
When do we advise against the procedure (for the time being)?
- In the case of recent or frequent seizures, or an epilepsy that is not yet well regulated [3]
- In the case of a history of a previous reaction to local anaesthetic [2]
- If your neurologist advises against the procedure at this time
Our advice
Do you have epilepsy and are you considering an eyelid correction? Always report this during the intake consultation, even if you have been seizure-free for years. During the consultation at Kliniek het Bolwerk we discuss your situation and, if necessary, contact your neurologist before we plan the procedure.
Literature references
The publications below form the medical-scientific basis of this article:
- Local anesthesia: neurologic complications. MedLink Neurology. 2026. https://www.medlink.com/articles/local-anesthesia-neurologic-complications
- Local anaesthetic-induced seizures: a review. Frontiers of Oral and Maxillofacial Medicine. 2024. https://fomm.amegroups.org/article/view/92958/html
- Anaesthesia and epilepsy. Continuing Education in Anaesthesia, Critical Care & Pain (ScienceDirect). 2012. https://www.sciencedirect.com/science/article/pii/S0007091217322602
- Two cases of anesthetics-induced epileptic seizures: a case report and literature review. Acta Epileptologica. 2022. https://link.springer.com/article/10.1186/s42494-021-00074-w
