Seizure burden before and after lidocaine as add-on therapy in (amplitude-integrated) electroencephalography-confirmed 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.