Abstract
Lidocame is either a convulsant or an anticonvulsant drug, according to the plasmatic levels. We used its anticonvulsant effect in seizures of various etiology. Lidocaineinfusion (L.I.) was efficient in 19/29 full term (FT) and in 10/13 premature babies (PT) with seizures (confirmed by EEG) resisting to Phenobarbital and Diazepam therapy. L.I. was given at decreasing dosage (4 mg/kg/h, day 1; 3mg/kg/h,day2; 2 mg/kg/h, day 3; 1 mg/kg/h, day 4). After L.I. beginning : -seizures were controlled within 30 min. in 23 cases, after 3 to 13 hours in 4 cases; -background EEG changed in some cases, immediatly or after a delay (up to 24 hours) into a very discontinuous pattern. In 2 cases L.I. alone did not control seizures, but an additional bolus (2 mg/Kg) was efficient. Plasmatic levels (mg/ml) obtained after 24 h of L.I. in 15 cases with seizure control were higher in 4 PT (9.5-10.5) than in 11 FT (3.1-8.9), with a lower clearance in PT. L. half-life varied from 30 min. to 3.6 hours in 6 FT and was 36 hours in one PT. Seizures initially stopped then reappared in 4 cases : plasmatic levels obtained in 2/4 after 12 hours of L.I. wore high : 13.4 in a PT and 11.7, suggesting the possible convulsant effect of L. high lcvel. There was however no hemodynamic change. In conclusion: in neonates, L. could help to control seizures resisting to usual anticonvulsant drugs. A bolus of 2 mg/kg followed by a LI. at 2 mg/Kg/h could avoid to attain convulsant level. Further pharmacological studies shoud help to determine optimal approach.
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Radvanyi-Bouvet, MF., Rcy, E., Marin, C. et al. 25 LIDOCAINEANTICONVULSANTTHERAPY in NEONATAL SEIZURES. Pediatr Res 28, 281 (1990). https://doi.org/10.1203/00006450-199009000-00049
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DOI: https://doi.org/10.1203/00006450-199009000-00049