A long-term outcome of intravenous infusion of lidocaine in pediatric cluster seizures – a preliminary study

Abstract Background Cluster seizures are life-threatening conditions. They may easily evolve into status epilepticus and are reported in up to 20–30% of patients with epilepsy. Sometimes cluster seizures become drug-resistant leading to the use of unconventional therapies. One of these unconventional approaches may be the use of lidocaine which is a sodium-channel blocking drug mostly known as a local anesthetic and antiarrhythmic agent. Methods We present a long-term outcome of 4 children who were treated with continuous intravenous infusion of 2% lidocaine due to drug-resistant focal cluster seizures. Lidocaine was administered at an initial dose of 1 mg/kg/hour and, subsequently, was increased to 2 – 4 mg/kg/hour. The therapy was continued for 5 to10 days. Patients remained under careful cardiological surveillance during the treatment. Results In all children, complete seizure remission was achieved. None of our patients experienced any adverse events. Although seizures recurred in all patients within an average time of 2.4 months, they appeared with reduced frequency and within a follow-up period (mean 7.5 months) no cluster seizures were observed. Conclusions Treatment with lidocaine in pediatric cluster seizures may be useful and may be considered as a therapeutic option. All our patients had no side effects and presented longer seizures remission, which may result from the supportive role of lidocaine on sodium channels or its anti-inflammatory properties. However, more studies are required to confirm the safety and long-term effectiveness of this approach. Clinicians should be aware of possible adverse effects and necessity of sustained cardiological surveillance during the treatment.