Lorazepam not better at treating children’s epileptic seizures

Lorazepam is not necessarily better at stopping epileptic seizures in children than diazepam, according to a new study published in the April 30 issue of JAMA.

Although some studies have suggested that lorazepam may be more effective or safer than diazepam in treating a type of epileptic seizures among children (pediatric status epilepticus), the randomized trial conducted by James M. Chamberlain, MD, with the Children’s National Medical Center in Washington, DC, and colleagues with the Pediatric Emergency Care Applied Research Network, found that it is not.

The study results have important implications for both outside the hospital and emergency department care. “Diazepam can be stored without refrigeration and thus has been used as the treatment of choice in many prehospital systems. The results of this study do not support the superiority of Lorazepam over diazepam as a first-line agent for pediatric status epilepticus,” Dr Chamberlain wrote.

The researchers randomly assigned 273 patients that were aged 3 months to 18 years with convulsive status epilepticus presenting to one of 11 pediatric emergency departments to receive diazepam or lorazepam intravenously.

The researchers found that the primary measure of effectiveness, cessation of status epilepticus for 10 minutes without recurrence within 30 minutes, occurred in 72.1% in the diazepam group and 72.9% in the lorazepam group. Twenty-six patients in each group required assisted ventilation (the primary safety outcome; 16% given diazepam and 17.6% given lorazepam).

They also found that there were no significant differences in other outcomes such as rates of seizure recurrence and time to cessation of convulsions, except that patients receiving lorazepam were more likely to experience sedation (67% vs 50% for those receiving diazepam).

The researchers suggest that future trials should consider newer medications and novel interventions targeting those at highest risk for medication failure or respiratory depression.