Tania Martins
Centro Hospitalar Sao Joao , Portugal
Title: The experience of lidocaine use in refractory seizures in a tertiary hospital
Biography
Biography: Tania Martins
Abstract
Introduction: Neonatal convulsions, with an incidence of 1.8-3.5/1000, are the most common symptoms of neurological dysfunction and may result from functional organic or metabolic disorders. Phenobarbital remains first therapeutic line drug with less than 50% effectiveness.
Aim: Aim of this study is to determine etiology, complementary means of diagnosis, treatment performed with special attention to the use of lidocaine as drugs of 3rd or 4th line and its efficacy in refractory seizures.
Methods: A retrospective review of refractory seizures admitted to the neonatal intensive care unit of a tertiary hospital in Portugal between 2009 and 2015. Results: Seven newborns (5M/2F) were diagnosed with refractory seizures (one preterm). Delivery dystocia em 6. Average birth weight was 3177 g. Perinatal asphyxia is the main cause in (3/7), ischemic/hemorrhagic stroke in 2, hypoxia associated to a cardio-pulmonary disease and one KCNQ2 gene mutation in 1 case. Imaging and electrophysiological studies were performed in all cases. First line drug was phenobarbital in all cases; 2nd line midazolam 5/7 and levetiracetam and phenytoin 1/7; 3rd line lidocaine in 5/7 and levetiracetam and clobazam 1/7, 4th line levetiracetam 3/5 and midazolam and lidocaine 1/5; 5th line thiopental 2/3 and lidocaine 1/3. Lidocaine was not associated with cardiac electrical changes and resulted in seizure control in 3/7. All infants underwent EEG control and kept antiepileptic therapy to discharge. Conclusions: The use of lidocaine resulted in a moderate control (42% crises) without cardiac effects. Lidocaine should therefore be considered earlier in the treatment of seizures in the neonatal period.