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Epilepsia. 2016 Feb;57(2):233-42. doi: 10.1111/epi.13286. Epub 2015 Dec 31.

Lidocaine response rate in aEEG-confirmed neonatal seizures: Retrospective study of 413 full-term and preterm infants.

Author information

1
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
2
Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland.
3
Section of Clinical Neurosciences, UCL - Institute of Child Health, London, United Kingdom.
4
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
5
Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVE:

To investigate the seizure response rate to lidocaine in a large cohort of infants who received lidocaine as second- or third-line antiepileptic drug (AED) for neonatal seizures.

METHODS:

Full-term (n = 319) and preterm (n = 94) infants, who received lidocaine for neonatal seizures confirmed on amplitude-integrated EEG (aEEG), were studied retrospectively (January 1992-December 2012). Based on aEEG findings, the response was defined as good (>4 h no seizures, no need for rescue medication); intermediate (0-2 h no seizures, but rescue medication needed after 2-4 h); or no clear response (rescue medication needed <2 h).

RESULTS:

Lidocaine had a good or intermediate effect in 71.4%. The response rate was significantly lower in preterm (55.3%) than in full-term infants (76.1%, p < 0.001). In full-term infants the response to lidocaine was significantly better than midazolam as second-line AED (21.4% vs. 12.7%, p = 0.049), and there was a trend for a higher response rate as third-line AED (67.6% vs. 57%, p = 0.086). Both lidocaine and midazolam had a higher response rate as third-line AED than as second-line AED (p < 0.001). Factors associated with a good response to lidocaine were the following: higher gestational age, longer time between start of first seizure and administration of lidocaine, lidocaine as third-line AED, use of new lidocaine regimens, diagnosis of stroke, use of digital aEEG, and hypothermia. Multivariable analysis of seizure response to lidocaine included lidocaine as second- or third-line AED and seizure etiology.

SIGNIFICANCE:

Seizure response to lidocaine was seen in ~70%. The response rate was influenced by gestational age, underlying etiology, and timing of administration. Lidocaine had a significantly higher response rate than midazolam as second-line AED, and there was a trend for a higher response rate as third-line AED. Both lidocaine and midazolam had a higher response rate as third-line compared to second-line AED, which could be due to a pharmacologic synergistic mechanism between the two drugs.

KEYWORDS:

Antiepileptic drugs; Lidocaine; Midazolam; Neonatal seizures; Response rate

PMID:
26719344
DOI:
10.1111/epi.13286
[Indexed for MEDLINE]
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