ABSTRACT
We evaluated the usefulness of intravenous lidocaine therapy for managing of status epilepticus (SE) during childhood in a retrospective multi-institutional study. Questionnaires were sent to 28 hospitals concerning patients admitted for SE who were managed with lidocaine, assessing patient characteristics, treatment protocols and efficacy. In 279 treated patients, 261 SE occurrences at ages between 1 month and 15 years were analyzed. SE was classified as showing continuous, clustered, or frequently repeated seizures. Considering efficacy and side effects in combination, the usefulness of lidocaine was classified into six categories: extremely useful, useful, slightly useful, not useful, associated with deterioration, or unevaluated. In 148 SE cases (56.7%), lidocaine was rated as useful or extremely useful. Multivariate analysis indicated lidocaine was to be useful in SE with clustered and frequently repeated seizures, and SE attributable to certain acute illnesses, such as convulsions with mild gastroenteritis. Efficacy was poor when SE caused by central nervous system (CNS) infectious disease. Standard doses (approximately 2mg/kg as a bolus, 2mg/kg/h as maintenance) produced better outcomes than lower or higher doses. Poor responders to the initial bolus injection of lidocaine were less likely to respond to subsequent continuous infusion than good initial responders. We recommend lidocaine for use in SE with clustered or frequently repeated seizures, and in SE associated with benign infantile convulsion and convulsions with mild gastroenteritis. Lidocaine should be initiated with a bolus of 2mg/kg. If SE is arrested by the bolus, continuous maintenance infusion should follow; treatment should proceed to different measures when SE shows a poor response to the initial bolus of lidocaine.
Subject(s)
Anesthetics, Local , Infusions, Intravenous , Lidocaine , Status Epilepticus/drug therapy , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Child , Child, Preschool , Female , Humans , Infant , Japan , Lidocaine/administration & dosage , Lidocaine/therapeutic use , Male , Multivariate Analysis , Odds Ratio , Retrospective Studies , Status Epilepticus/physiopathology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
CASE REPORT: A neonate who had schizencephaly associated with ipsilateral chronic subdural fluid collection in the neonatal period is described. A boy was born to a healthy Japanese woman. After birth, the boy presented with rapid expansion of head circumference. Computed tomography (CT) and magnetic resonance images (MRI) of the head demonstrated left schizencephaly combined with a midline shift attributable to hydrocephalus. Thereafter, the patient gradually presented other symptoms caused by increased intracranial pressure. Ultrasonography and MRI of the head showed the presence of a subdural fluid collection overlaid on the schizencephaly. We identified the outer membrane by burr-hole craniotomy. CONCLUSION: This was a rare case of schizencephaly associated with hydrocephalus and the formation of ipsilateral chronic subdural fluid collection.
