Effect of topiramate, in combination with lidocaine, and phenobarbital, in acute encephalitis with refractory repetitive partial seizures.
OBJECTIVE
Acute encephalitis with refractory repetitive partial seizure (AERRPS) is a peculiar type of post-encephalitic/encephalopathic epilepsy. Here we report an analysis of AERRPS in a series of children and propose an effective treatment option for seizure control in these children.


METHODS
We retrospectively reviewed cases of AERRPS treated in a pediatric intensive care unit, between February 2002 and June 2006. Clinical characteristics were systemically assessed. Burst suppression coma was induced by high-dose suppressive therapy; 24-h electroencephalogram (EEG) monitoring was performed on each patient. The goal of treatment was to achieve complete clinical seizure control or burst-suppression pattern on EEG, aiming for an interburst interval of >5s. Brain imaging was done for each patient.


RESULTS
There were nine patients (seven boys), aged 5-15 years. Clinical symptoms included fever (100%), upper respiratory symptoms (66.7%) and altered consciousness (66.7%). All patients received multiple high-dose suppressive drugs and were intubated with/without inotropic agents. Seizures in three patients were stopped after high-dose lidocaine infusion (6-8 mg/kg/h) in the acute stage and three patients were stopped after high dose phenobarbital (serum level 60-80 ug/mL) combined with high-dose oral topiramate (15-20 mg/kg/day). Follow-up for this study was 16-61 months. Two subjects died while seven developed epilepsy and/or neurologic deficits; none returned to baseline. All survivors were discharged and continued multiple antiepileptic medications.


CONCLUSIONS
Our data indicates that children with AERRPS have high mortality and morbidity rates. High-dose topiramate combined with high-dose lidocaine infusion or high-dose phenobarbital in the acute stage might be an effective treatment option for children with AERRPS.
Lin
Jainn-Jim
JJ
Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Lin
Kuang-Lin
KL
Wang
Huei-Shyong
HS
Hsia
Shao-Hsuan
SH
Wu
Chang-Teng
CT
D000208:Acute Disease; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D004569:Electroencephalography; D004660:Encephalitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D010634:Phenobarbital / Q000627:therapeutic use*; D011859:Radiography; D012720:Severity of Illness Index; D013577:Syndrome; D000077236:Topiramate; D016896:Treatment Outcome
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose; D008012:Lidocaine; D010634:Phenobarbital