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Per rectal diazepam therapy in convulsive disorders
A Kalra1, N Chaturvedi, V M Vashishtha
1Department of Pediatrics, S.N. Medical College, Agra.
Insights
Rectal diazepam effectively treated persistent convulsions in children, with intravenous diazepam showing slightly higher efficacy. Both methods were safe, though intravenous administration was more effective for primary generalized seizures.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Persistent convulsions in children require prompt and effective treatment.
- Diazepam is a common first-line agent for seizure control.
Purpose of the Study:
- To compare the efficacy and safety of rectal versus intravenous diazepam in treating pediatric convulsions.
- To evaluate the effectiveness of different diazepam administration routes across various seizure types and etiologies.
Main Methods:
- A comparative study involving 120 children treated with rectal diazepam (0.2-0.7 mg/kg) and 100 children treated with intravenous diazepam (0.2-0.3 mg/kg).
- Children refractory to rectal therapy also received intravenous diazepam.
- Efficacy and side effects were monitored and statistically analyzed.
Main Results:
- Rectal diazepam was effective in 80.83% of cases; intravenous diazepam was effective in 90% (p < 0.05).
- No significant difference in efficacy was noted for most seizure types and etiologies.
- Intravenous diazepam demonstrated superior efficacy in primary generalized seizures (p < 0.05).
- Rectal diazepam had no significant side effects; 19.17% of rectal treatments failed, with 10% responding to subsequent intravenous administration.
Conclusions:
- Both rectal and intravenous diazepam are effective in managing pediatric convulsions.
- Intravenous administration offers a statistically significant advantage for primary generalized seizures.
- Rectal diazepam is a safe and viable alternative, particularly when intravenous access is challenging.
Abstract:
One hundred and twenty children with persistent convulsions (lasting > or = 10 min) were treated with per rectal diazepam (dosage: 0.2 to 0.7 mg/kg/dose). Another group of 100 age matched children with convulsions, along with those who did not respond to rectal therapy were given intravenous diazepam in a dosage of 0.2 to 0.3 mg/kg/dose. Rectal treatment was effective in 80.83% cases while intravenous diazepam was effective in 90% cases which is statistically just significant (p < 0.05). No significant difference was observed in the efficacy of two routes of administration in controlling convulsions of different clinical types and various etiological groups (p < 0.05), except for primary generalized type where intravenous route was more effective than the rectal one (p < 0.05). No significant side-effect was observed with rectal therapy. Among the 23 (19.17%) children in whom rectal therapy failed, 12 (10%) responded to intravenous diazepam while the remaining 11 (9.17%) cases were resistant to both routes of administration.