IV lidocaine: a second line drug therapy for pediatric convulsive status epilepticus?

ABSTRACT

Refractory convulsive Status Epilepticus [SE] which does not respond to first line drugs [benzodiazepines, phenytoin and phenobarbital] heralds an emergency condition, in pediatric neurology which can cause irreparable brain damage. There is no consensus on the choice of drug treatment for refractory generalized convulsive status epilepticus in children. Lidocaine is a valuable forgotten antiepileptic agent with favorable properties which include prompt responses, less alteration of consciousness, and fewer adverse effects such as less respiratory depression. In a retrospective study conducted to investigate clinical efficacy and safety of intravenous lidocaine in treating refractory generalized convulsive SE of children, the medical records of 13 patients admitted to the Shaheed Sadoughi Hospital of Yazd between 2003 and 2005 and treated with intravenous lidocaine, were reviewed. 13 patients, 7 girls and 6 boys [average age 3 years, SD=2.7years] were treated with lidocaine. Neurodevelopmental delay was seen in 38.5%, and in 46.2% of them EEG and neuroimaging abnormalities were observed. Seizures ceased in eight patients [61/5%], without any undesirable side effects. Two patients had to be intubated because of non-responsiveness to lidocaine, and other treatments were begun. Mean duration of ICU stay was 4.77 days, SD=3days. It is recommended that lidocaine be used as a second-line, anticonvulsive drug in the treatment of status epilepticus, especially when faced with unavailability of appropriate respiratory care and intubation equipment