Lidocaine treatment in pediatric convulsive status epilepticus.
BACKGROUND
Convulsive status epilepticus (CSE) may end fatally or leave serious sequelae. CSE treatment, invariably an emergency case, is based upon i.v. benzodiazepines as well as phenytoin, barbiturates or both. The present paper reports efficiency of lidocaine in CSE.


METHODS
The effects of lidocaine on patients with CSE due to infectious and non-infectious reasons were compared. Lidocaine was given in 29 episodes of CSE to 49 patients having failed to respond to first-line anticonvulsive drugs, such as diazepam, phenobarbital and phenytoin therapy. Lidocaine was given in doses of 2 mg/kg bolus i.v., and then in 4 mg/kg per h infusion.


RESULTS
Mean duration of lidocaine infusion was 14.6 +/- 7.8 h. Effectiveness of lidocaine in patients with CSE was found to be 44.4%. Also, 11 patients responded to a single dose of lidocaine (37.9%), while another two (6.9%) required another dose to suppress their seizures. Patients with seizures attributable to infections were observed to have responded favorably to lidocaine when compared to those with seizures due to epilepsy (37.9% vs 6.8%; P < 0.05). Subsequent epilepsy was found to occur more frequently in patients with a poor response to lidocaine than in patients with a good response (P < 0.05). Adverse reactions to lidocaine were observed in three patients (10.3%), two of them having ventricular arrhythmia. As for the other patient, the focal seizure developed into a generalized one.


CONCLUSIONS
Lidocaine seems to be useful for the management of CSE as a rapid-acting anticonvulsant, particularly in patients with CSE due to infections. But further studies with larger number of patients are needed.
Yildiz
Bilal
B
Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey. bilalyn@yahoo.com
Citak
Agop
A
Uçsel
Raif
R
Karaböcüoğlu
Metin
M
Aydinli
Nur
N
Uzel
Nedret
N
D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D013226:Status Epilepticus / Q000188:drug therapy*
D000927:Anticonvulsants; D008012:Lidocaine