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NeoReviews Vol.9 No.12 2008 e585
© 2008 American Academy of Pediatrics

Pharmacology Review

Lidocaine for Neonatal Seizure Management

Carin M.A. Rademaker, PharmD, PhD^*
Linda S. de Vries, MD, PhD

^* Clinical Pharmacologist, Department of Clinical Pharmacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
Professor in Neonatal Neurology, Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands

Abbreviations: aEEG: amplitude-integrated electroencephalography • GX: glycinexylidide • MEGX: monoethylglycinexylidide

The first 300 words of the full text of this article appear below.

	Introduction

 
The incidence of neonatal seizures is 3.5/1,000 live births. (1) The clinical manifestations are very diverse and not always easy to recognize. Amplitude-integrated electroencephalography (aEEG), a method for continuous monitoring of brain function used increasingly in neonatal intensive care units, (2) may aid in recognition of neonatal seizures. Apart from being able to detect abnormal brain activity, aEEG also enables immediate and continuous evaluation of the effect of anticonvulsive treatment. aEEG often reveals electrographic discharges without clinical manifestations, especially following initiation of drug therapy for clinical seizures. (3)(4) Continuation of electrographic seizures without a clinical correlate is referred to as "uncoupling." (3)

Several studies have shown that the success rate of the most commonly used anticonvulsant drugs, phenobarbitone and phenytoin, frequently is disappointing in neonates. (5) Lidocaine is an effective drug for second- or third-line treatment of neonatal seizures not responding to traditional anticonvulsant therapy. (6)(7)(8) In this article, we review the effectiveness and safety of lidocaine and discuss the clinical value of routine measurements of drug concentrations because of the pharmacokinetic and pharmacodynamic properties of lidocaine. We hypothesize the effects of therapeutic hypothermia on lidocaine drug disposition and response.

	Historical Background

 
Lidocaine is used widely as a local anesthetic for pain prevention and as a type 1b antiarrhythmic agent for short-term control of ventricular arrhythmias. In 1948, the drug was synthesized as an amide derivative of the anesthetic cocaine. Lidocaine acts as a central nervous system depressant with sedative, analgesic, and anticonvulsant properties.

Scandinavia has a long therapeutic tradition of using lidocaine for the treatment of severe neonatal seizures. Hellström-Westas and associates (7) showed in 1988 that lidocaine was effective in most patients suffering clinically suspected epileptic seizures that persisted in . . . [Full Text of this Article]

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