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Seizure Burden before and after Lidocaine as Add-On Therapy in (Amplitude-Integrated)
Mathies Rondagh1, Bregje O van Oldenmark2, Andrea van Steenis2
1Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands, m.rondagh@lumc.nl.
Insights
Lidocaine (LDC) significantly reduced total seizure burden (TSB) and maximum hourly seizure burden (MSB) in neonates with electroencephalography-confirmed seizures. Most neonates experienced 100% seizure reduction, with many remaining seizure-free for at least 72 hours.
Area of Science:
- Neonatal Neurology
- Clinical Neurophysiology
Background:
- Neonatal seizures pose significant challenges, often requiring add-on therapies.
- Amplitude-integrated electroencephalography (aEEG) is crucial for confirming neonatal seizures.
Purpose of the Study:
- To evaluate the efficacy of lidocaine (LDC) as an add-on therapy for neonatal seizures.
- To assess the impact of LDC on total seizure burden (TSB) and maximum hourly seizure burden (MSB).
- To determine seizure freedom rates and the need for additional anti-seizure medications (ASMs).
Main Methods:
- Retrospective cohort study of neonates with persistent seizures despite phenobarbital.
- Continuous 2-channel aEEG monitoring.
- Calculation of TSB and MSB using raw EEG data 4 hours pre- and post-LDC administration.
Main Results:
- Lidocaine administration led to a significant reduction in median TSB (31 to 0 min) and MSB (10 to 0 min/h).
- 71% of neonates achieved seizure freedom for at least 24 hours, and 52% for 72 hours.
- Only 3% required additional ASMs within 4 hours, while 41% needed them within 24 hours.
Conclusions:
- Lidocaine is effective in significantly reducing seizure burden in neonates.
- LDC achieves substantial seizure reduction and prolonged seizure freedom in a majority of cases.
- LDC represents a valuable add-on treatment option for refractory neonatal seizures.
Abstract:
Introduction: The primary aim of this study was to evaluate the total seizure burden (TSB) and maximum hourly seizure burden (MSB) before and after the administration of lidocaine (LDC) as add-on therapy in neonates with amplitude-integrated electroencephalography (aEEG)-confirmed seizures. Secondary aims were documenting the need for additional ASM at 4, 12, and 24 h after LDC and the rate of seizure freedom for at least 24, 48, and 72 h after LDC.
Methods:
This single-center, retrospective cohort study included neonates with persistent seizures after phenobarbital who received add-on LDC therapy. Neonates were monitored with a continuous 2-channel aEEG. The TSB and MSB were calculated using raw EEG data collected 4 h before and after the administration of LDC.
Results:
Sixty-one neonates were included. Seizure etiology consisted of hypoxic-ischemic encephalopathy (n = 24), hemorrhagic or ischemic stroke (n = 16), central nervous system infection (n = 7), genetic (n = 8), metabolic disorders (n = 4), and unknown etiology (n = 2). After LDC administration, median TSB decreased significantly from 31 (interquartile range [IQR] 16-68) to 0 min (IQR 0-0, p < 0.01) and MSB from 10 (IQR 6-41) to 0 min/h (IQR 0-0, p < 0.01). The need for additional ASM was 3% (2/61) within 4 h and 41% (25/61) within 24 h. Seizure freedom after LDC was achieved in 71% (42/59) for at least 24 h and 52% (29/56) for 72 h.
Discussion:
LDC significantly reduced TSB and MSB in neonates with (a)EEG-confirmed seizures, achieving 100% seizure reduction in the majority, with half of the neonates remaining seizure-free for at least 72 h.
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