The Status Epilepticus following Local Anesthetic Toxicity and Phenytoin induced Dyskinesia: A Case Report

Abstract

Phenytoin is effective antiseizure medication which frequently prescribed in clinical practice. Involuntary movements are a less familiar complication of treatment with phenytoin and include tremor, asterixis, myoclonus and tardive dyskinesia. A case report of 6-year-old boy was refered from private hospital with history of accidental falling and he had lacerated wound at both forearm from stone cuts and during stitched suture at emergency room he had developed symptoms of convulsive status epilepticus. He received diazepam 5 mg intravenous 2 doses (0.3 mg/kg) and loading dose of phenytoin 400 mg (21.6 mg/kg) intravenous and stop seizure. He was unconscious and need intubated. He was refered to Chonburi hospital and was given maintenance dose 5 mg/kg/day intravenous of phenytoin. The second day of admission he was noted to have abnormal movement as tardive dyskinesia consisting of facial grimacing, tongue protrusion, eyebrow elevation and limbs dyskinesia. General and neurological examination were normal. Blood test and cerebrospinal fluid exam were normal. We reviewed history of patient’s treatment and all drugs usage and found that he was injected 2% lidocaine amount of 10 cc or 200 mg (10.8 mg/kg) for local anesthesia during stitched wounds, his body weight 18.5 kg which over than toxic dose of Lidocain is 4.5 mg/kg. Conclusion that lidocaine toxicity caused convulsive statue epilepticus and phenytoin was immediately discontinued. The tardive dyskinesia resolved after withdrawal of phenytoin. The patient returned to normal in the third day of admission.

Keywords : Local anesthetic toxicity, status epilepticus, Phenytoin-Anticonvulsants, Tardive dyskinesia