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Intravenous diazepam, midazolam and lorazepam in acute seizure control
Geeta Gathwala1, Mayank Goel, Jagjit Singh
1Departments of Pediatrics, Pt. B.D.Sharma PGIMS, University of Health Sciences Rohtak, 6J/8, Medical Enclave, Rohtak, 124001 Haryana, India. g_gathwala@hotmail.com
Insights
Parenteral lorazepam and midazolam are effective for acute seizures in children, with fewer complications than diazepam. Diazepam showed higher rates of seizure abnormalities and somnolence.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Neurology
Background:
- Acute seizures in children require prompt and effective treatment.
- Benzodiazepines are commonly used for seizure control.
- Parenteral administration is often necessary in emergency settings.
Purpose of the Study:
- To compare the safety and efficacy of parenteral lorazepam, midazolam, and diazepam in controlling acute seizures in children.
- To evaluate seizure cessation time and adverse events associated with each drug.
Main Methods:
- A randomized study involving 120 children (6 months to 14 years) with acute seizures.
- Patients were divided into three equal groups receiving diazepam, midazolam, or lorazepam.
- Primary outcome: time to seizure cessation; Secondary outcome: side effects; Statistical analysis: Student's t-test and chi-square test.
Main Results:
- Seizure cessation time was comparable across all three drug groups (diazepam: 84.94±38.56s, midazolam: 92.69±25.97s, lorazepam: 91.12±23.58s).
- Diazepam group had significantly more seizure abnormalities (27.5%) and required a second dose more often (10%) compared to lorazepam (5% and 0%, respectively).
- Excessive somnolence was significantly higher in the diazepam group.
Conclusions:
- Parenteral lorazepam, midazolam, and diazepam demonstrate comparable efficacy in terms of time to seizure cessation.
- Lorazepam and midazolam appear to be safer alternatives to diazepam, with lower rates of seizure abnormalities and somnolence.
- Diazepam use was associated with a higher incidence of excessive somnolence and a greater need for repeat dosing.
Objective:
To evaluate the safety and efficacy of three benzodiazepine drugs: Lorazepam, Midazolam and Diazepam, when given parenterally in the control of acute seizure.
Methods:
One hundred and twenty children of either sex in the age group 6 month to 14 years brought convulsing to the pediatric emergency services, were enrolled in the study. These were randomised to three equal groups of 40 patients each; Group A-received diazepam, Group B-received midazolam, Group C-received lorazepam. End of seizure episode (clinically) was defined as cessation of visible epileptic phenomenon or return of purposeful response to external stimuli within 15 min of drug administration. A stopwatch was used to measure various time intervals accurately. The patient's vitals were monitored and recorded in a predesigned performa. The primary outcome was the time to seizure cessation and secondary outcome was the side effects of the drugs. Data obtained was analysed statistically using student's t-test and chi-square test.
Results:
Mean duration to clinical seizure cessation was comparable among the three groups. For diazepam group it was 84.94 ± 38.56 s, for midazolam group it was 92.69 ± 25.97 s, for lorazepam group it was 91.12 ± 23.58 s. Number of patients with any abnormality in seizure cessation were significantly higher in diazepam group [11/40 (27.5%)] when compared to the midazolam [4/40 (10%)] and lorazepam group [2/40 (5%)]. Number of patients requiring 2nd dose to control seizures was significantly higher [4/40 (10%)] in diazepam group when compared to lorazepam group [0/40 (0%)] but diazepam and midazolam and midazolam and lorazepam were comparable in this aspect.All the three drugs were comparable in terms of side effects except excessive somnolence which was significantly higher in diazepam group.
Conclusions:
All the three groups were comparable in terms of time to clinical seizure cessation, seizure recurrence and uncontrolled seizures after drug administration. However, number of patients requiring second dose to control seizures were significantly higher in diazepam group when compared to lorazepam group. Excessive somnolence and sedation occurred more frequently with diazepam.
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