Phenytoin or paraldehyde as the second drug for convulsions in children

Date First Published:

March 1, 2000

Last Updated:

January 17, 2003

Report by:

Will Townend, Specialist Registrar (Manchester STEM)

Search checked by:

Kevin Mackway-Jones, Manchester STEM

Three-Part Question:

In a [child continuing to fit after two doses of benzodiazepines] is [phenytoin or paraldehyde] more effective in [controlling seizure activity]?

Clinical Scenario:

A fitting three year old child presents to the emergency department. The child has received an appropriate dose of rectal diazepam from the prehospital team. Following administration of a dose of intravenous lorazepam the child continues to fit. You wonder whether there is any evidence to suggest whether paraldehyde or phenytoin should be given next.

Search Strategy:

Medline 1966 to 11/02 using the OVID interface.

Search Details:

({exp seizures OR seizure$.mp OR fit$.mp OR exp convulsions OR epilep$.mp OR exp epilepsy} AND {exp paraldehyde OR paraldehyde.mp} AND {phenytoin.mp OR fosphenytoin.mp OR exp phenytoin}) LIMIT to human AND English

Outcome:

44 papers found of which none were relevant to the original question.

Author Commentary:

There is no research in this area.

Bottom Line:

Consensus guidelines should be followed.