Pediatric Department, Faculty of Medicine, Universidad de La Laguna, S/C Tenerife, Spain.
Department of Neonatology, Hospital Universitario de Canarias, S/C Tenerife, Spain.
J Clin Neurophysiol. 2024 Jul 1;41(5):450-457. doi: 10.1097/WNP.0000000000001013. Epub 2023 Apr 25.
To assess the clinical effectiveness of treating acute seizures with midazolam and lidocaine infusion.
This single-center historical cohort study included 39 term neonates with electrographic seizures who underwent treatment with midazolam (1st line) and lidocaine (2nd line). Therapeutic response was measured using continuous video-EEG monitoring. The EEG measurements included total s eizure burden (minutes), maximum ictal fraction (minutes/hour), and EEG-background (normal/slightly abnormal vs. abnormal). Treatment response was considered good (seizure control with midazolam infusion), intermediate (need to add lidocaine to the control), or no response. Using clinical assessments supplemented by BSID-III and/or ASQ-3 at 2 to 9 years old age, neurodevelopment was classified as normal, borderline, or abnormal.
A good therapeutic response was obtained in 24 neonates, an intermediate response in 15, and no response in any of the neonates. Babies with good response showed lower values in maximum ictal fraction compared with those with intermediate response (95% CI: 5.85-8.64 vs. 9.14-19.14, P = 0.002). Neurodevelopment was considered normal in 24 children, borderline in five, and abnormal in other 10 children. Abnormal neurodevelopment was significantly associated with an abnormal EEG background, maximum ictal fraction >11 minutes, and total s eizure burden >25 minutes (odds ratio 95% CI: 4.74-1708.52, P = 0.003; 1.72-200, P = 0.016; 1.72-142.86, P = 0.026, respectively) but not with the therapeutic response. Serious adverse effects were not recorded.
This retrospective study suggests that the midazolam/lidocaine association could potentially be efficacious in decreasing seizure burden in term neonates with acute seizures. These results would justify testing the midazolam/lidocaine combination as a first-line treatment for neonatal seizures in future clinical trials.
评估咪达唑仑和利多卡因输注治疗急性惊厥的临床疗效。
这是一项单中心历史队列研究，纳入了 39 例有脑电图痫性发作的足月新生儿，他们接受咪达唑仑（一线治疗）和利多卡因（二线治疗）治疗。治疗反应通过连续视频脑电图监测来衡量。脑电图测量包括总痫性发作负担（分钟）、最大痫性发作分数（分钟/小时）和脑电图背景（正常/轻度异常与异常）。治疗反应被认为是好（咪达唑仑输注控制发作）、中等（需要添加利多卡因控制）或无反应。在 2 至 9 岁时，通过临床评估补充 BSID-III 和/或 ASQ-3 对神经发育进行分类，分为正常、边缘或异常。
24 例新生儿获得良好的治疗反应，15 例获得中等反应，无任何新生儿无反应。具有良好反应的婴儿的最大痫性发作分数低于具有中等反应的婴儿（95%CI：5.85-8.64 与 9.14-19.14，P=0.002）。24 例儿童的神经发育被认为是正常的，5 例是边缘的，10 例是异常的。异常神经发育与异常脑电图背景、最大痫性发作分数>11 分钟和总痫性发作负担>25 分钟显著相关（优势比 95%CI：4.74-1708.52，P=0.003；1.72-200，P=0.016；1.72-142.86，P=0.026），但与治疗反应无关。未记录到严重不良事件。
这项回顾性研究表明，咪达唑仑/利多卡因联合治疗可能有助于降低急性惊厥足月新生儿的痫性发作负担。这些结果将证明在未来的临床试验中，咪达唑仑/利多卡因联合治疗作为新生儿惊厥的一线治疗是合理的。
