Treatment of status epilepticus

Abstract

In a randomized, nonblinded clinical trial, 36 consecutive patients with generalized convulsive status epilepticus were treated with either combination diazepam and phenytoin (DZ/DPH) or phenobarbital (PB). Phenytoin was added to the PB regimen if seizures persisted for 10 minutes after beginning therapy. The cumulative convulsion time (total time spent in active convulsive movements) was shorter for the PB group than for the DZ/DPH group (median, 5 versus 9 minutes, p less than 0.06); the response latency (elapsed time from initiation of therapy to the end of the last convulsion) was also shorter for the PB group (median, 5.5 versus 15 minutes, p less than 0.10). The median cumulative convulsion time is between 0 and 14 minutes shorter for the PB regimen than for the DZ/DPH regimen (95% confidence interval). Similarly, the median response latency for the PB regimen is between 1 minute longer and 20 minutes shorter than that for the DZ/DPH regimen (95% confidence interval). The frequencies of intubation, hypotension, and arrhythmias were similar in the two groups. Eleven of 18 patients in the PB group responded to phenobarbital monotherapy. We conclude that the PB regimen is rapidly effective, comparable in safety, and enjoys certain practical advantages in comparison with the DZ/DPH regimen.

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

“…Nine RCTs (three class I [22][23][24], one class II [25], and five class III [26][27][28][29][30]) addressed the efficacy of initial therapy. The 1998 Veteran's Affairs status epilepticus study was a multicenter randomized comparison of four different IV treatments: lorazepam (0.1 mg/kg), diazepam (0.15 mg/kg) followed by phenytoin (18 mg/kg), phenobarbital (18 mg/kg), and phenytoin alone (18 mg/kg) in adults with either overt or subtle status epilepticus (22).…”

Enhancement of GABAergic Activity: Neuropharmacological Effects of Benzodiazepines and Therapeutic Use in Anesthesiology

“…Other shortcomings include adverse events, such as delirium and sedation should be remembered. Several randomized controlled trials support the use of diazepam and lorazepam as initial drug therapy in patients with status epilepticus (Shaner et al, 1988;Treiman et al, 1998;Alldredge et al, 2001). A randomized double-blind trial demonstrated the effectiveness of intravenous diazepam on status epilepticus when the drugs were administered by paramedics before patients arrived at the hospital (Alldredge et al, 2001).…”

“…Results from four comparative studies have suggested that lorazepam is superior to phenytoin and as effective as clonazepam, diazepam, or the combination of diazepam and phenytoin in the initial treatment of status epilepticus (Sorel et al, 1981;Shaner et al, 1988;Treiman et al, 1998;Alldredge et al, 2001). Large lorazepam doses (0.3-9 mg/ h) have been used for treating refractory status epilepticus and lorazepam has been shown to terminate status epilepticus efficiently (Labar et al, 1994).…”

Children presenting with convulsions (including status epilepticus) to a paediatric accident and emergency department: an audit of a treatment protocol

“…Previous reports have been largely adult-based (Shaner et al 1988, Martin and Millac 1994, Walker et al 1995 frequently using different protocols. Although there is some information on children presenting to A and E, details of the drugs given and their doses were not included in these reports (Mathes and Wallace 1995, Scholtes et al 1996, Smith et al 1996.…”