Lidocaine Treatment in Refractory Status Epilepticus Resulting from Febrile Infection-Related Epilepsy Syndrome: A Case Report and Follow-Up

Abstract

We report the management of refractory status epilepticus (SE) by using continuous intravenous infusions of lidocaine in a previously healthy 15-year-old girl with a “catastrophic encephalopathy” in whom a diagnosis of febrile infection-related epilepsy syndrome was supposed. One week after a banal pharyngitis and fever, the patient presented confusion and intractable clusters of seizures. Although she underwent multiple examinations investigating all possible etiologies (intracranial infection, autoimmune disease, or toxic and metabolic illness), all results were negative except a feeble positivity to Mycoplasma pneumoniae serum antibodies. SE was initially treated with benzodiazepine followed by administration of barbiturates and subsequent induction of coma because of refractory SE; different antiepileptic drugs (AEDs) were given at different times in a period of 6 weeks but clinical and electroencephalographic improvements were achieved only after continuous infusion of lidocaine. When she recovered from SE, the patient developed severe psychomotor and cognitive impairment associated with cerebral atrophy. Treatment with lidocaine or other alternative drugs in cases of prolonged SE should be taken into account as soon as it becomes clear that the clinical condition is refractory to common AEDs included in available guidelines for SE treatment, to improve the bad outcome of this severe condition, at least limiting the negative effects of prolonged high metabolic demand due to continuous epileptiform activity and/or the possible negative effects of prolonged burst-suppression coma.

Keywords

FIRES - children - epilepsy - lidocaine - status epilepticus

• References

• 1 Ismail FY, Kossoff EH. AERRPS, DESC, NORSE, FIRES: multi-labeling or distinct epileptic entities?. Epilepsia 2011; 52 (11) e185-e189
• 2 Pardo CA, Nabbout R, Galanopoulou AS. Mechanisms of epileptogenesis in pediatric epileptic syndromes: Rasmussen encephalitis, infantile spasms, and febrile infection-related epilepsy syndrome (FIRES). Neurotherapeutics 2014; 11 (2) 297-310
• 3 Nabbout R. FIRES and IHHE: Delineation of the syndromes. Epilepsia 2013; 54 (Suppl. 06) 54-56
• 4 van Baalen A, Häusler M, Plecko-Startinig B , et al. Febrile infection-related epilepsy syndrome without detectable autoantibodies and response to immunotherapy: a case series and discussion of epileptogenesis in FIRES. Neuropediatrics 2012; 43 (4) 209-216
• 5 Caraballo RH, Reyes G, Avaria MF , et al. Febrile infection-related epilepsy syndrome: a study of 12 patients. Seizure 2013; 22 (7) 553-559
• 6 Sort R, Born AP, Pedersen KN, Fonsmark L, Uldall P. Ketogenic diet in 3 cases of childhood refractory status epilepticus. Eur J Paediatr Neurol 2013; 17 (6) 531-536
• 7 Kossoff EH, Nabbout R. Use of dietary therapy for status epilepticus. J Child Neurol 2013; 28 (8) 1049-1051
• 8 Minicucci F, Muscas G, Perucca E, Capovilla G, Vigevano F, Tinuper P. Treatment of status epilepticus in adults: guidelines of the Italian League against Epilepsy. Epilepsia 2006; 47 (Suppl. 05) 9-15
• 9 Lin JJ, Lin KL, Wang HS, Hsia SH, Wu CT. Effect of topiramate, in combination with lidocaine, and phenobarbital, in acute encephalitis with refractory repetitive partial seizures. Brain Dev 2009; 31 (8) 605-611
• 10 Hattori H, Yamano T, Hayashi K , et al. Effectiveness of lidocaine infusion for status epilepticus in childhood: a retrospective multi-institutional study in Japan. Brain Dev 2008; 30 (8) 504-512