Abstract Details

Title Marked Response to Lidocaine Plus MgSO4 Treatment in a New Onset Febrile Infection-Related Refectory Status Epilepticus

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-003

Objective To describe a rare case of severe refractory epilepsy and its successful management.

Background Febrile infection-related epilepsy syndrome (FIRES) is a subgroup of the epileptic syndromes known as severe new onset status epilepticus (NORSE). FIRES is described in the literature as a devastating explosive-onset epileptic encephalopathy with refractory repetitive seizures preceded by a nonspecific febrile illness. This syndrome occurs in previously healthy young children and is associated with a high rate of mortality. Lidocaine and magnesium has been successfully used in several pediatric cases to control refractory status epilepticus (RSE). However, there is not a consensus on the use of lidocaine in RSE in the adult population.

Design/Methods Case Report and literature review

Results 20 year-old woman with no significant past medical history presented with acute encephalopathy and RSE after recurrent febrile episodes during the month preceding seizures. Extensive infectious, metabolic, inflammatory and paraneoplastic workup was negative. Treatment with multiple anti-epileptic medications (AED) and a ketogenic diet as well as episodes of burst suppression coma with 48-hour intervals was attempted with no effect. Magnetic Resonance Imaging of brain showed bilateral hippocampal, mesiotemporal and frontal T2 changes. A brain biopsy revealed nonspecific inflammatory changes. The patient received Intravenous Immunoglobulin and high dose steroid and one infusion of cyclophosphamide with no benefit. On hospital day 52, she was started on Lidocaine and MgSO4 after which her seizure frequency gradually improved. Patient weaned off of sedation, on few AEDs, and was conscious and able to follow commands.

Conclusions This case report is significant for demonstrating that Lidocaine and MgSO4 can be a possible last resort treatment for adults with FIRES who do not respond to typical AEDs and other treatment methods employed for super-refractory seizures. This can bring attention to new possible treatment options for severe refractory epilepsy for cases that would otherwise have a poor prognosis.

Authors/Disclosures
Helen B. Burks, MD (Cincinnati Children’s Hospital Medical Center) PRESENTER	No disclosure on file
Barlas Benkli, MD	No disclosure on file
Mahsa Khayat-Khoei, MD	The institution of Dr. Khayat-Khoei has received research support from The National MS Society of America, for Fellowship Award.
Yigit Karasozen, MD	Dr. Karasozen has nothing to disclose.
Shaun O. Smart, MD	Dr. Smart has nothing to disclose.

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Abstract Details