A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus

Background: It is uncertain whether the administration of benzodiazepines b y paramedics is an effective and safe treatment for out-of-hospital status epilepticus. Methods: We conducted a randomized, double-blind trial to evaluate intraven ous benzodiazepines administered by paramedics for the treatment of out-of- hospital status epilepticus. Adults with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures received intravenous d iazepam (5 mg), lorazepam (2 mg), or placebo. An identical second injection was given if needed. Results: Of the 205 patients enrolled, 66 received lorazepam, 68 received d iazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepa m (59.1 percent) or diazepam (42.6 percent) than patients given placebo (21 .1 percent) (P=0.001). After adjustment for covariates, the odds ratio for termination of status epilepticus by the time of arrival in the lorazepam g roup as compared with the placebo group was 4.8 (95 percent confidence inte rval, 1.9 to 13.0). The odds ratio was 1.9 (95 percent confidence interval, 0.8 to 4.4) in the lorazepam group as compared with the diazepam group and 2.3 (95 percent confidence interval, 1.0 to 5.9) in the diazepam group as compared with the placebo group. The rates of respiratory or circulatory co mplications after the study treatment was administered were 10.6 percent fo r the lorazepam group, 10.3 percent for the diazepam group, and 22.5 percen t for the placebo group (P=0.08). Conclusions: Benzodiazepines are safe and effective when administered by pa ramedics for out-of-hospital status epilepticus in adults. Lorazepam is lik ely to be a better therapy than diazepam. (N Engl J Med 2001;345:631-7.) Co pyright (C) 2001 Massachusetts Medical Society.