Therapy resistant seizures

[junaidmuhib]

I have a VLBW baby with grade IV IVH. He has siezuers inspite of have high doses of Phenobarb, Phenytoin, Midazolam infusuion and also on Fentanyl.

If anybody can help on this to how to control siezures in this baby.

Thanks

[Stefan Johansson]

A difficult case!

Are the infant on all the mentioned drugs or have you tried one by one?

Are the seizures confirmed by EEG?

Have you tried to give pyridoxin (vit B6)?

Lidokain may be an option too.

[sudershan.kumari]

what about increase in head sizre and state of fontanels, specially anterior fontanel. in case of increased cs pressure, csf drainage might be helpful by reducing intracranial pressure

[Guest IsmailH]

Dear Stefan,

It it an interesting on the use of Lidocaine in the treatment of neonatal seizures. However, not much literature available for us to follow. It would be helpful (for me) if you can provide the protocol on this drug.

Thanks

IsmailH

Malaysia

[Stefan Johansson]

Firstly and importantly, we use lidokain only when fenobarbital and/or midazolam fails to control seizures.

The dose we recommend in our (local) protocol is as loading dose of 2 mg/kg, and continued by 2-6 mg/kg/hour. ECG surveillance is mandatory and we try seponate within 48 hours.