けいれん発作群発に対するリドカイン持続静注の有効性について(<特集>小児科学教室大澤真木子教授開講5周年記念)

けいれん発作を反復する群発状態は,日常生活を障害し,発作重積状態に移行したり,神経学的後遺症を残す可能性があり,早急に対処すべき症候である.けいれん発作群発を呈し,ジアゼパムの直腸内または静脈内投与が無効であった22症例に対して,リドカイン持続静注療法を試みた.「群発」は繰り返すけいれん発作の間欠期に意識が回復する状態とし,発作頻度は(1)初回けいれん発作の場合には24時間以内に3回以上,(2)てんかん症例では,日常的な発作頻度を超え通常の生活に支障を来す状態,と規定した.リドカインは1～4mg/kgを静注後,1～4mg/kg/hrで持続静注を行った.初回発作で基礎疾患のない,神経学的に正常な9症例は平均年齢1歳4カ月で,熱性けいれんの家族歴が高かった.7例ではリドカイン開始後に発作の再燃はなく,中止による再発を認めなかった.1例では発作消失したが中止後に再発し,リドカイン再導入して消失した.1例ではリドカイン無効であった.てんかんの1歳8カ月から22歳までの13例では,17エピソードの発作群発に対して,発作消失3例4エピソード,発作減少5例6エピソード,無効7例7エピソードであった.有効例と無効例とを比較して,年齢,発達障害,神経学的合併症の有無,リドカイン使用量について比較したが,差を認めなかった.両群とも呼吸,循環動態,意識水準,睡眠覚醒リズム,食事摂取などに明らかな影響を認めなかった.ジアゼパム抵抗性の発作群発状態に対して,リドカイン持続静注は基礎疾患のない,発達正常な乳幼児に対してきわめて有用であった.基礎疾患を有し,てんかんとして治療中の発作群発状態には有効率が低いが,副作用なく著効例もあるため,エピソードの早期に試みる方法である.Clusters of seizures, which has been defined as acute repetitive seizures in between which the patient regains consciousness, is a not uncommon event in clinical practice, and may present considerable health risks to patients. In this setting, continuous intravenous (iv) lidocaine treatment was performed in 22 patients whose cluster of seizures did not respond to rectal or intravenous diazepam (DZP). With cardiac and respiratory monitoring, the patients were administered an iv lidocaine dose of 1 to 4 mg/kg followed by continuous iv lidocaine (1 to 4 mg/kg/hr). In 9 patients in whom episodes of convulsions recurred more than 3 times within 24 hours and who had no underlying disorder with normal development at onset, 7 patients experienced no relapse of seizures after the start of the treatment. Relapse occurred only once in one other patient after termination of lidocaine but disappeared after reinfusion, and one patient had no response. In 17 episodes of 13 patients, who had been diagnosed with epilepsy and in whom the frequency of seizures disturbed their daily routine, seizures were terminated in 3 patients with 4 episodes. The incidence of seizures was decreased in 5 patients with 6 episodes, and there was an absence of response in 7 patients with 7 episodes. Continuous iv lidocaine was particularly useful for clusters of seizures seen in infants with normal development and no underlying disorder. Lidocaine was less effective in patients with refractory epilepsy, although some cases were controlled completely. These results suggest that lidocaine treatment should be tried at an early stage in clusters of seizures

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes