Pediatric Status Epilepticus: Lorazepam vs Diazepam?

James Chamberlain, MD Division Chief, Emergency Medicine Children’s National Health System Washington, DCMedicalResearch.com Interview with:
James Chamberlain, MD
Division Chief, Emergency Medicine
Children’s National Health System
Washington, DC


MedicalResearch: What are the main findings of the study?

Dr. Chamberlain: Contrary to our hypothesis, lorazepam was not superior to diazepam for treating pediatric seizures. Both medications had similar effectiveness (72-73%) and safety (15-16% incidence of assisted ventilation). Lorazepam caused a longer period of sedation prior to waking up. The difference was approximately 15 minutes.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Chamberlain: Either diazepam or lorazepam should be considered acceptable first-line therapy for pediatric status epilepticus. Diazepam has the advantage that it can be stored without refrigeration, making it an excellent choice for ambulances. Taken together with the results of the RAMPART study, which compared IM midazolam to IV lorazepam, any of the three benzodiazepines can be considered acceptable as a first-line agent.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Chamberlain: 28% of patients failed therapy with either lorazepam or diazepam. We do not know the optimal medication when this happens. Traditionally, we have used phenytoin or fos-phenytoin. The next large trial will compare fos-phenytoin to levetiracetam and valproic acid to determine optimal therapy for those who do not respond to the benzodiazepines.

Citation:

Chamberlain JM, Okada P, Holsti M, et al. Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial. JAMA. 2014;311(16):1652-1660. doi:10.1001/jama.2014.2625.