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Seizure. 2015 Sep;31:41-8. doi: 10.1016/j.seizure.2015.07.003. Epub 2015 Jul 13.

Lidocaine for status epilepticus in adults.

Author information

1
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada. Electronic address: umzeiler@cc.umanitoba.ca.
2
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada. Electronic address: kaitlinzeiler@gmail.com.
3
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Canada.
4
Section of Neurocritical Care, Montreal Neurological Institute, McGill, Montreal, Canada; Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada.
5
Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada; Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada.

Abstract

INTRODUCTION:

Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in adults for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control.

METHODS:

All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers.

RESULTS:

Overall, 13 studies were identified, with 11 manuscripts and 2 meeting abstracts. Seventy-six adult patients were treated for 82 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 1-12, on board prior to lidocaine therapy. During 69 of the 82 (84.1%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some utilizing bolus dosing alone; others utilizing a combination of bolus and infusion therapy. Overall, 70.7% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 64.1% and 6.1% respectively. Patient outcomes were sparingly reported.

CONCLUSIONS:

There currently exists level 4, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the adult population. Thus there is currently weak evidence to support the use of lidocaine in this context. Further prospective studies of lidocaine administration in this setting are warranted.

KEYWORDS:

Adult; Lidocaine; Refractory; Status epilepticus

PMID:
26362376
DOI:
10.1016/j.seizure.2015.07.003
[Indexed for MEDLINE]
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