Bk. Alldredge et al., A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus, N ENG J MED, 345(9), 2001, pp. 631-637
Citations number
19
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
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.