A case of acute encephalitis with repetitive refractory partial seizures successfully treated with lidocaine

Abstract

　　A 5-year-old girl was admitted to a hospital due to status epilepticus the day after the onset of fever. Although a midazolam infusion was initially effective, seizures frequently occurred and the patient became dependent on continuous thiopental infusion under mechanical ventilation. She was then diagnosed with acute encephalopathy with refractory repetitive partial seizures (AERRPS) based on her clinical course. Multiple antiepileptic drugs, high-dose phenobarbital, ketogenic diet, and a vagal nerve stimulation had no effect. However, continuous lidocaine infusion completely controlled the seizures and she was withdrawn from thiopental. Subsequently, the lidocaine infusion was successfully replaced by oral mexiletine. Lidocaine infusion is one of the treatment options for the patients with AERRPS who are refractory to conventional treatments and require barbiturate coma.