title: Marked improvement in febrile infection-related epilepsy syndrome after lidocaine plus MgSO4 treatment in a 12-year-old girl.
abstract: OBJECTIVE
  This report sheds light on a successful treatment in febrile infection-related epilepsy syndrome (FIRES) with the combined use of lidocaine and MgSO4.
  
  
  METHODS
  We report a 12-year-old previously healthy girl who experienced an upper respiratory infection with fever and headache for 2 days, then suddenly went into a coma followed by repetitive status epilepticus. All tests for CNS infection, metabolic and toxic diseases, and autoimmune encephalitis were negative. Hence, the diagnosis of FIRES was made. During 5 weeks of hospital treatment, various antiepileptic drugs were administered at different times without success. To achieve seizure control, we then attempted the use of lidocaine first, then followed by MgSO4.
  
  
  RESULTS
  The SE was successfully controlled when lidocaine plus MgSO4 was introduced. At follow-up, almost no neurological sequelae remained.
  
  
  CONCLUSIONS
  This is the first report describing the combined use of lidocaine and MgSO4 with successful treatment outcomes. This experience has indicated that even FIRES can be controlled if treated promptly with certain agents. However, more studies are needed to explore the mechanisms and effects of lidocaine and MgSO4 in FIRES.
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: I-Ching
authors.initials: IC
authors.lastname: Chou
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Huan-Cheng
authors.initials: HC
authors.lastname: Lai
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan; Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Fuu-Jen
authors.initials: FJ
authors.lastname: Tsai
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Sheng-Shing
authors.initials: SS
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Children's Hospital, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Syuan-Yu
authors.initials: SY
authors.lastname: Hong
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Inn-Chi
authors.initials: IC
authors.lastname: Lee
keywords: FIRES; Febrile infection-related epilepsy syndrome; Lidocaine; MgSO4; Status epilepticus