Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions.

Abstract

INTRODUCTION:

The aim of this prospective audit was to assess the effectiveness and safety of rectal paraldehyde in the management of acute, including prolonged, tonic-clonic convulsions. There are very limited published data on its effectiveness and safety, and previous data have focused on its intramuscular route of administration.

METHODS:

Four hospitals participated in the study. Information was collected on each dose of paraldehyde used for the treatment of a tonic-clonic convulsion over 1 year. Data were not included on patients treated with rectal paraldehyde for other seizure types or non-convulsive status epilepticus.

RESULTS:

Data analysis was undertaken regarding 53 episodes in 30 patients. Patient's ages ranged from 5 months to 16 years (mean 6.12 years, median 5.91 years). A pre-existing diagnosis of epilepsy was recorded in 35 episodes (66%). The mean dose of paraldehyde was 0.65 ml/kg (SD 0.22, 95% CI 0.59 to 0.71) and median dose 0.79 ml/kg. Rectal paraldehyde terminated the convulsion in 33 (62.3%) of the 53 episodes. In the 35 episodes where a pre-existing diagnosis of epilepsy was recorded, paraldehyde stopped the convulsion on 26 (74.3%) occasions. There was no difference in the dose of paraldehyde between the episodes where the convulsion was or was not terminated. There was no recorded respiratory depression in any episode.

CONCLUSIONS:

This study provides unique evidence that rectal paraldehyde is effective and safe in treating acute prolonged tonic-clonic convulsions. This would appear to confirm that paraldehyde should remain a treatment for the management of prolonged tonic-clonic convulsions, including convulsive status epilepticus.

• Authors: A G Rowland, A M Gill, A B Stewart, R E Appleton, A Al Kharusi, C Cramp, L-K Yeung
• Journal: Archives of disease in childhood (Arch Dis Child) Vol. 94 Issue 9 Pg. 720-3 (Sep 2009) ISSN: 1468-2044 [Electronic] England
• PMID: 19357123 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anticonvulsants
• Paraldehyde

Topics

• Acute Disease
• Administration, Rectal
• Adolescent
• Anticonvulsants (administration & dosage, therapeutic use)
• Child
• Child, Preschool
• Drug Administration Schedule
• Epilepsy, Tonic-Clonic (drug therapy)
• Humans
• Infant
• Medical Audit (methods)
• Paraldehyde (administration & dosage, therapeutic use)
• Prospective Studies
• Safety
• Treatment Outcome