We searched the Cochrane
Epilepsy Group's Specialized Register (1st July 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2007), and MEDLINE (1966 to July 2007).
SELECTION CRITERIA: Two review authors independently assessed trials for inclusion and extracted data. We contacted study authors for additional information.
MAIN RESULTS: Four trials involving 383 participants were included.(1) Intravenous
lorazepam is as effective as intravenous
diazepam in the treatment of acute
tonic clonic convulsions, 19/27 (70%) versus 22/34 (65%), RR 1.09 (95% CI 0.77 to 1.54), has fewer adverse events and rectal
lorazepam may be more effective than rectal
diazepam, 6/6 versus 6/19 (31%), RR 3.17 (95% CI 1.63 to 6.14)(2) Buccal
midazolam controlled
seizures in 61/109 (56%) compared with 30/110 (27%) of rectal
diazepam treated episodes with acute
tonic-clonic convulsions, RR 2.05 ( 95% CI 1.45 to 2.91)(3) Intranasal
midazolam is as effective as intravenous
diazepam in the treatment of prolonged
febrile convulsions, 23/26 (88%) versus 24/26 (92%), RR 0.96 (95% CI 0.8 to 1.14)(4) There is moderate evidence that intranasal
lorazepam is more effective than intramuscular
paraldehyde for acute
tonic-clonic convulsions and patients treated with intranasal
lorazepam are significantly less likely to require further
anticonvulsants to control continuing
seizures, 8/80 (10%) versus 21/80 (26%), RR 0.58 (95% CI 0.42 to 0.79).
AUTHORS' CONCLUSIONS: The conclusions of this update have changed to suggest that intravenous
lorazepam is at least as effective as intravenous
diazepam and is associated with fewer adverse events in the treatment of acute
tonic-clonic convulsions. Where intravenous access is unavailable there is evidence from one trial that buccal
midazolam is the treatment of choice.