Diazepam convulsive status epilepticus

Cock HR, Schapira AH. A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM 2002 95(4) 225-31. 

In a multicenter, randomized, double-blind comparison of diazepam (0.15 mg/kg followed by phenytoin 18 mg/kg), lorazepam (0.1 mg/kg), phenobarbital (15 mg/kg), and phenytoin (18 mg/kg) in 518 patients with generalized convulsive status epilepticus, lorazepam was more effective than phenytoin and at least as effective as phenobarbital or diazepam plus phenytoin (1). Drug-related adverse effects did not differ significantly among the treatments and included hypoventilation (up to 17%), hypotension (up to 59%), and cardiac rhythm disturbances (up to 9%). 

An 8-month-old boy who had been given oral modifled-release theophylline and additional aminophylline suppositories developed convulsive status epilepticus [96 ]. A combination of diazepam, lidocaine, and thiopental was required to stop the convulsion. A pharmacokinetic study showed that the use of the mod-ified-release formula would have given a plasma concentration of no more than 15 mg/ 1, but that the addition of aminophylline would have increased it to over 20 mg/1. 

Chen L, Feng P, Wang J, Liu L, Zhou D. Intravenous sodium valproate in mainland China for the treatment of diazepam refractory convulsive status epilepticus. J Clin Neurosci 2009 16(4) 524-6. 

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Parenteral Adjunct in status epilepticus and severe recurrent convulsive seizures. Rectal For selected, refractory patients on stable regimens of anti-epileptic agents who require intermittent use of diazepam to control bouts of increased seizure activity. 

Given intravenously, both diazepam and midazolam are effective first-line treatments for status epilepticus. It is essential to be aware that the large doses that may be necessary to control convulsions are likely to cause respiratory depression and obtund protective reflexes. Oxygen and equipment suitable for its administration should be available. For intractable status epilepticus, clonazepam is a longer-acting alternative which can also be given by intravenous infusion. Overdosage... 

No. Antipyretics may make the child feel more comfortable, but there is no evidence that they reduce the incidence or severity of febrile convulsions. Anticonvulsants certainly have no role to play. If a febrile convulsion does happen they are generally tonic or tonic-clonic and last just a couple of minutes. If they were to continue for longer than 5 minutes then conventional treatment for status epilepticus should be used (rectal diazepam or buccal midazolam). 

The use of intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus has been evaluated in a double-blind, randomized trial in 205 adults (54). The patients presented either with seizures lasting 5 minutes or more or with repetitive generalized convulsive seizures, and were randomized to receive intravenous diazepam 5 mg, loraze-pam 2 mg, or placebo. Status epilepticus was controlled on arrival at the hospital in significantly more patients taking benzodiazepines than placebo (lorazepam 59%, diazepam 43%, placebo 21%). The rates of respiratory or circulatory complications related to drug treatment were 11% with lorazepam, 10% with diazepam, and 23% with placebo, but these differences were not significant. 

Seizures are present in 30% of patients with star fruit intoxication [17], and most patients have convulsive [6, 8,10,11,13,14,17,18,19] or non-convulsive [16] status epilepticus. The mortality rate of patients with seizures occurring after star fruit intoxication (severe intoxication) is significantly higher than of patients without seizures [13, 17]. Phenytoin, midazolam, diazepam and phenobarbital seem to have little or no effect on the control of persistent seizures provoked by star fruit toxicity. However, significant clinical improvement of seizure was demonstrated in one patient after the use of profofol [20]. 

Given the conditions and the requirements for the initial symptomatic treatment of mass casualties, the diazepam derivative avizafone in autoinjectors and/or midazolam for intramuscular injection should be sufficient. In view of lo-razepam s reported efficacy in treatment of status epilepticus, it is recommended that more experimental studies are performed on the efficacy of lorazepam, and also in controlling nerve-agent-induced seizures and convulsions. 

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