Successful management of intractable epilepsy with lidocaine tapes and continuous subcutaneous lidocaine infusion

PURPOSE: We report the successful management of a 10-year-old girl with intractable frontal lobe epilepsy by using lidocaine tapes and continuous subcutaneous lidocaine infusion. METHODS: This patient's seizures were refractory to conventional antiepileptic drugs (AEDs) and mexiletine, but they responded well to the intravenous infusion of lidocaine. The intravenous infusion of lidocaine was replaced by lidocaine tape therapy, and subsequently by continuous subcutaneous lidocaine infusion therapy. The lidocaine tape (Penles, Nihon Lederle, Tokyo Japan) used was a stamp-sized (30.5 x 50.0 mm) tape containing 18 mg of lidocaine. We used 25 lidocaine tapes every 12 h (50 tapes/day). Lidocaine hydrochloride (10%) was administered continuously at a dose of 1.5 mg/kg/h (0.3 ml/hour) through a 27-G needle that was inserted in the subcutaneous tissue. RESULTS: Lidocaine tape therapy showed good efficacy for 1 year. After that, six lidocaine tapes were added 6 h after the exchange of 25 lidocaine tapes [62 tapes/day (25,6,25,6)], because the seizures became frequent when the lidocaine tapes were being exchanged. The seizures were then well controlled, but dermatitis due to the lidocaine tapes grew serious, and lidocaine tape therapy had to be stopped. Continuous subcutaneous infusion of lidocaine applied in place of lidocaine tapes provided long-term seizure control without remarkable side effects. CONCLUSIONS: Lidocaine tape therapy and continuous subcutaneous lidocaine infusion therapy were considered to be useful for controlling this patient's seizures. This is the first report to describe the efficacy of continuous subcutaneous lidocaine infusion therapy for epilepsy.