Lorazepam or diazepam in paediatric status elipticus
Date First Published:
March 1, 2000
Last Updated:
April 21, 2006
Report by:
Vince Choudhery, Specialist Registrar (North Western Emergency Medicine Specialist Registrar NW Rotation)
Search checked by:
Will Townend, North Western Emergency Medicine Specialist Registrar NW Rotation
Three-Part Question:
In [children in status epilepticus] is [lorazepam better than diazepam] at [safely terminating the seizure]?
Clinical Scenario:
A 2 year old is brought to the emergency department with a first presentation of fitting secondary to febrile illness. She has been fitting for >30 minutes. You obtain intravenous access and wonder if lorazepam or diazepam would be best at terminating the fit safely.
Search Strategy:
Medline 1966-9/99 using OVID interface.
Ovid MEDLINE 1966 to March Week 3 2006
OVID Embase 1980 to 2006 Week 12
The Cochrane Library 2006, Issue 1
Ovid MEDLINE 1966 to March Week 3 2006
OVID Embase 1980 to 2006 Week 12
The Cochrane Library 2006, Issue 1
Search Details:
Medline:({status epilepticus.mp. OR exp epilepsy/ OR epilep$.mp. OR exp seizures/ OR convulsions.mp. OR fit$.mp.} AND {exp lorazepam OR lorazepam.mp.} AND {exp diazepam/ OR diazepam.mp.} AND BestBETs Paediatric filter. LIMIT to Humans and English Language
Embase: ({status epilepticus.mp. OR exp epilepsy/ OR epilep$.mp. OR seizure$.mp OR exp convulsion/ OR fit$.mp.} AND {exp lorazepam OR lorazepam.mp.} AND {exp diazepam/ OR diazepam.mp.} AND [exp emergency ward/] LIMIT to Humans and English Language and (infant <to one year> or child <unspecified age> or preschool child <1 to 6 years> or school child <7 to 12 years> or adolescent <13 to 17 years>)
Cochrane:(status epilepticus *drug therapy [MeSH] AND child [MeSH]) 11 articles – 1 relevant
Embase: ({status epilepticus.mp. OR exp epilepsy/ OR epilep$.mp. OR seizure$.mp OR exp convulsion/ OR fit$.mp.} AND {exp lorazepam OR lorazepam.mp.} AND {exp diazepam/ OR diazepam.mp.} AND [exp emergency ward/] LIMIT to Humans and English Language and (infant <to one year> or child <unspecified age> or preschool child <1 to 6 years> or school child <7 to 12 years> or adolescent <13 to 17 years>)
Cochrane:(status epilepticus *drug therapy [MeSH] AND child [MeSH]) 11 articles – 1 relevant
Outcome:
65 references found on all three databases, of which 2 were relevant to the question. These are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Appleton RE, Sweeney A, Choonara I, Robson J, Molyneux E. 1995, UK | 102 children attending the Emergency department with acute convulsions and status epilepticus Odd and even dates. 53 Diazepam (0.3-0.4 mg/kg) vs 33 Lorezepam (0.05-0.1 mg/kg) 16 excluded from study due to inappropriate dose given |
Controlled trial | Seizure control with a single dose | 76% vs 51% | Not blinded |
| Comparative audit of intravenous lorazepam and diazepam in the emergency treatment of convulsive status epilepticus in children. Qureshi A, Wassmer E, Davies P et al. 2002, UK | 46 children attending the Emergency Department with prolonged seizure. 17 Diazepam (0.3 mg/kg) vs 31 Lorezepam (0.1 mg/kg) |
Controlled trial | Seizure control within 5 min of cannula insertion | 65% vs 65% | Not blinded, Not randomised |
Author Commentary:
A Cochrane review has been published on this topic, but includes the first paper only. This BET does not address the issue of the relative safety of the two treatments.
Bottom Line:
Lorazepam and diazepam are equally effective at seizure control in children.
References:
- Appleton RE, Sweeney A, Choonara I, Robson J, Molyneux E.. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus.
- Qureshi A, Wassmer E, Davies P et al.. Comparative audit of intravenous lorazepam and diazepam in the emergency treatment of convulsive status epilepticus in children.