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SEATTLE — Intravenous lorazepam is more effective than rectal diazepam in stopping status epilepticus in children who present to the emergency department with seizures that began at home, judging from findings from an English study.
The finding challenges earlier reports that suggested the two agents are equivalent for this indication, especially given the contention that it is easier to administer rectal drugs than to start an intravenous line outside the hospital.
Most of the existing data on optimal treatment come from hospital-based research, which “doesn't take into consideration the different time periods: what happens in the community, what happens on arrival into hospital, what happens after failure of first-line treatment in hospital,” Dr. Richard F. Chin said at the annual meeting of the American Epilepsy Society.
From May 2002 to April 2004, investigators in the ongoing North London Status Epilepticus in Childhood Surveillance Study prospectively collected population-based data at 22 North London hospitals about children who experienced community-onset convulsive status epilepticus.
During the study period, 240 episodes of community-onset convulsive status epilepticus were documented in 182 children, reported Dr. Chin, the study's lead investigator and a pediatric neurologist with the Institute of Child Health in London. The children had a median age of 3.2 years, and 52% were girls.
Overall, 2% percent of the episodes ended without any treatment. Another 61% were initially treated outside the hospital, and of these 22% were terminated before hospital arrival.
In multivariate analyses of the 203 episodes that were treated in the hospital, children were more than three times as likely to have termination of their seizures with first-line therapy in the emergency department if that therapy was intravenous lorazepam instead of rectal diazepam.
“That is very important because current guidelines, certainly within the [United Kingdom and other settings], suggest some degree of potential equivalence between a choice of rectal medication and [intravenous] medication,” he said. “Some people think there is a bit of concern getting IV access and administering medication. Certainly, there doesn't seem to be any basis for this within our setting.”
When first-line therapy failed, children were nearly nine times more likely to have seizure termination with second-line therapy if that therapy was intravenous phenytoin instead of rectal paraldehyde.
Dr. Chin had no relevant conflicts of interest to report.
SEATTLE — Intravenous lorazepam is more effective than rectal diazepam in stopping status epilepticus in children who present to the emergency department with seizures that began at home, judging from findings from an English study.
The finding challenges earlier reports that suggested the two agents are equivalent for this indication, especially given the contention that it is easier to administer rectal drugs than to start an intravenous line outside the hospital.
Most of the existing data on optimal treatment come from hospital-based research, which “doesn't take into consideration the different time periods: what happens in the community, what happens on arrival into hospital, what happens after failure of first-line treatment in hospital,” Dr. Richard F. Chin said at the annual meeting of the American Epilepsy Society.
From May 2002 to April 2004, investigators in the ongoing North London Status Epilepticus in Childhood Surveillance Study prospectively collected population-based data at 22 North London hospitals about children who experienced community-onset convulsive status epilepticus.
During the study period, 240 episodes of community-onset convulsive status epilepticus were documented in 182 children, reported Dr. Chin, the study's lead investigator and a pediatric neurologist with the Institute of Child Health in London. The children had a median age of 3.2 years, and 52% were girls.
Overall, 2% percent of the episodes ended without any treatment. Another 61% were initially treated outside the hospital, and of these 22% were terminated before hospital arrival.
In multivariate analyses of the 203 episodes that were treated in the hospital, children were more than three times as likely to have termination of their seizures with first-line therapy in the emergency department if that therapy was intravenous lorazepam instead of rectal diazepam.
“That is very important because current guidelines, certainly within the [United Kingdom and other settings], suggest some degree of potential equivalence between a choice of rectal medication and [intravenous] medication,” he said. “Some people think there is a bit of concern getting IV access and administering medication. Certainly, there doesn't seem to be any basis for this within our setting.”
When first-line therapy failed, children were nearly nine times more likely to have seizure termination with second-line therapy if that therapy was intravenous phenytoin instead of rectal paraldehyde.
Dr. Chin had no relevant conflicts of interest to report.
SEATTLE — Intravenous lorazepam is more effective than rectal diazepam in stopping status epilepticus in children who present to the emergency department with seizures that began at home, judging from findings from an English study.
The finding challenges earlier reports that suggested the two agents are equivalent for this indication, especially given the contention that it is easier to administer rectal drugs than to start an intravenous line outside the hospital.
Most of the existing data on optimal treatment come from hospital-based research, which “doesn't take into consideration the different time periods: what happens in the community, what happens on arrival into hospital, what happens after failure of first-line treatment in hospital,” Dr. Richard F. Chin said at the annual meeting of the American Epilepsy Society.
From May 2002 to April 2004, investigators in the ongoing North London Status Epilepticus in Childhood Surveillance Study prospectively collected population-based data at 22 North London hospitals about children who experienced community-onset convulsive status epilepticus.
During the study period, 240 episodes of community-onset convulsive status epilepticus were documented in 182 children, reported Dr. Chin, the study's lead investigator and a pediatric neurologist with the Institute of Child Health in London. The children had a median age of 3.2 years, and 52% were girls.
Overall, 2% percent of the episodes ended without any treatment. Another 61% were initially treated outside the hospital, and of these 22% were terminated before hospital arrival.
In multivariate analyses of the 203 episodes that were treated in the hospital, children were more than three times as likely to have termination of their seizures with first-line therapy in the emergency department if that therapy was intravenous lorazepam instead of rectal diazepam.
“That is very important because current guidelines, certainly within the [United Kingdom and other settings], suggest some degree of potential equivalence between a choice of rectal medication and [intravenous] medication,” he said. “Some people think there is a bit of concern getting IV access and administering medication. Certainly, there doesn't seem to be any basis for this within our setting.”
When first-line therapy failed, children were nearly nine times more likely to have seizure termination with second-line therapy if that therapy was intravenous phenytoin instead of rectal paraldehyde.
Dr. Chin had no relevant conflicts of interest to report.