Stick with diazepam for status epilepticus

Contrary to what many practitioners believe, lorazepam is no better than diazepam for pediatric convulsive status epilepticus, according to the results of a new double-blind, randomized trial.

Researchers from around the country participating in the Pediatric Emergency Care Applied Research Network found that despite the results of some smaller and/or retrospective studies, lorazepam is no more effective and safer than diazepam in patients aged 3 months to 18 years with the convulsive form of the condition.

In fact, the only real difference between the 2 groups of children was that 67% of the children receiving lorazepam required sedation versus 50% of those receiving diazepam (P<0.05). Otherwise, efficacy was almost identical. Cessation of status epilepticus by 10 minutes without recurrence for 30 minutes occurred in 72.1% of the diazepam group and in 72.9% of the lorazepam group, for an absolute difference of 0.8%. The number of patients in each group requiring assisted ventilation was also similar: 16% for the diazepam group versus 17.6% for the lorazepam group (absolute difference, 1.6%).

The investigators studied a total of 273 patients presenting to 1 of 11 US academic pediatric emergency departments with generalized tonic-clonic seizures and loss of consciousness: 140 received 0.2 mg/kg diazepam and 133 received 0.1 mg/kg lorazepam, with half the dose repeated at 5 minutes if necessary. Other agents were provided if patients continued to convulse at 12 minutes.

The researchers noted that diazepam might make more sense from a practical point of view. It doesn’t require refrigeration, making it easier for paramedics to start in a mobile setting.

According to the American Academy of Pediatrics, status epilepticus is any seizure that continues for 30 minutes or intermittent seizures lasting for 30 minutes or longer in which the person does not regain consciousness between the episodes.

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