[P3-53] Efficacy of lidocaine in a patient with malignant migrating partial seizures in infancy
[Purpose] The syndrome of malignant migrating partial seizures of infancy (MMPSI) is characterized by early onset of multiple seizure types. The seizures often tend to remain intractable and outcome is generally unfavorable. On the other hands, there are few reports concerned with the efficacy of lidocaine for MMPSI. We report a case of MMPSI showing a good response by lidocaine.
[Case report] A year and 4-month-old boy was born normally at gestational week 40. The patient was born without asphyxia, but hemiconvulsions with secondary generalization after moving to the contralateral side were evident on Day 1 at age, and the frequency was gradually increased. An interictal EEG showed a continuous pattern of slow waves with shifting from one hemisphere to the other side as background activity, and multifocal paroxysmal discharges were present. Ictal EEG demonstrated rhythmic theta activity beginning in one region and progressively expanded to contiguous regions. In addition, the discharges migrated to the opposite hemisphere occasionally. The first treatment with continuous intravenous midazolam led to improvement temporarily, however at Day 5, the seizures reappeared and occasionally persisted in clusters. Treatment was changed to add the continuous intravenous lidocaine on Day 21, which led to immediate improvement in seizures. After 16 days, we replaced the continuous intravenous lidocaine to oral mexiletine. At present, he had been seizure free by treated in combination with mexiletine and clobazam, and acquired competences in all developmental domains at this stage.
[Conclusion] Lidocaine may represent an important addition to the treatments available for MMPSI.
[Case report] A year and 4-month-old boy was born normally at gestational week 40. The patient was born without asphyxia, but hemiconvulsions with secondary generalization after moving to the contralateral side were evident on Day 1 at age, and the frequency was gradually increased. An interictal EEG showed a continuous pattern of slow waves with shifting from one hemisphere to the other side as background activity, and multifocal paroxysmal discharges were present. Ictal EEG demonstrated rhythmic theta activity beginning in one region and progressively expanded to contiguous regions. In addition, the discharges migrated to the opposite hemisphere occasionally. The first treatment with continuous intravenous midazolam led to improvement temporarily, however at Day 5, the seizures reappeared and occasionally persisted in clusters. Treatment was changed to add the continuous intravenous lidocaine on Day 21, which led to immediate improvement in seizures. After 16 days, we replaced the continuous intravenous lidocaine to oral mexiletine. At present, he had been seizure free by treated in combination with mexiletine and clobazam, and acquired competences in all developmental domains at this stage.
[Conclusion] Lidocaine may represent an important addition to the treatments available for MMPSI.