The use of lamotrigine in nonconvulsive status epilepticus in children

초록

Introduction: Status epilepticus is a pediatric neurologic emergency that requires rapid assessment and management. Nonconvulsive status epilepticus(NCSE) can be classified as generalized or partial, and classification requires EEG, as it is difficult to differentiate solely by clinical manifestations. Though it is not rare, it is difficult to diagnosis and many cases have been reported to be unresponsive to treatment. Although there is ongoing controversy of the effectiveness of active treatment, serious neurologic defects may occur when not treated for a long-time period. Therefore urgent treatment is crucial in NCES. Material and Method: This report includes two patients who were admitted with a diagnosis of NCES to the ICU in Inha University Hospital from 2008-2009. All patients had received oral admission of lamotrigine. They were continuously monitored by portal EEG and receive intensive care without intubation or mechanical ventilation. Results: Case 1 : An 8-year-old boy visited our hospital with a chief complaint of bilateral fixation of eyes toward the left-side for 1 day, which developed less than 5 minutes after event of headache, blindness and cyanosis 2 days ago. EEG showed nearly rhythmic 4-5Hz activity on the temporal region(F8) and MRI revealed a pachygyria in the right hemisphere. Anticonvulsant treatment with lamotrigine was initiated at the dose of 25mg/d(1mg/kg/d) and was increased to 100mg/d(4mg/kg/d) over 2days, when the patient’s seizure diminished and EEG showed normal rhythms. Seizure has not relapsed for the past 7 months.