Oral mexiletine for lidocaine-responsive neonatal epilepsy
Mika Nakazawa1, Akihisa Okumura, Shinichi Niijima
1Department of Pediatrics, Juntendo University Faculty of Medicine, Japan; Department of Pediatrics, Juntendo Nerima Hospital, Japan. mknakaza@juntendo.ac.jp
Insights
Oral mexiletine effectively treated neonatal epilepsy that was unresponsive to other therapies. This medication provided long-term seizure control without impacting psychomotor development in the infant patient.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Neonatal epilepsy presents a significant clinical challenge, often requiring tailored therapeutic strategies.
- Refractory epilepsy in neonates necessitates exploration of alternative treatment options beyond standard antiepileptic drugs.
Observation:
- A male neonate experienced seizures starting at 2 days of age, resistant to phenobarbital, lamotrigine, vitamin B6, and midazolam.
- Continuous lidocaine infusion demonstrated efficacy in controlling the patient's seizures.
- Subsequent treatment with oral mexiletine achieved sustained seizure control at serum levels of 0.2-0.4μg/ml.
Findings:
- The patient achieved long-term seizure control with oral mexiletine.
- Genetic analysis revealed no mutations in SCN1A, SCN1B, KCNQ2, and KCNQ3 genes.
- No psychomotor development delay was noted at 20 months of age.
Implications:
- Oral mexiletine represents a viable therapeutic option for neonatal epilepsy responsive to lidocaine.
- This case expands treatment possibilities for refractory neonatal seizures.
- Further research into mexiletine for specific epilepsy phenotypes is warranted.
Abstract:
We report a patient with lidocaine-responsive neonatal epilepsy treated successfully with oral mexiletine. The patient was a male neonate who had seizures since 2days of age. While his seizures were refractory to phenobarbital, lamotrigine, vitamin B6, and midazolam, they were controlled by continuous lidocaine infusion. Oral mexiletine at serum levels of 0.2-0.4μg/ml was used successfully for long-term treatment of his seizures. No delay in psychomotor development was observed at the last follow-up at 20months of age. No mutation was identified in any of four genes: SCN1A, SCN1B, KCNQ2, and KCNQ3. Our patient demonstrates that oral mexiletine can be useful for long-term treatment of patients with lidocaine-responsive epilepsy.
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