Pre-hospital and emergency department treatment of convulsive status epilepticus in adults: an evidence synthesis

In review (4 trials; n=1345 [1234 adults]), 3 trials showed both IV lorazepam & IV diazepam (DZ) administered by paramedics are more effective vs. placebo; IM midazolam (MD) is non-inferior to IV lorazepam. None of trials was conducted in UK & none assessed buccal MD or rectal DZ

SPS commentary:

Findings included the following:

  • Median time to seizure cessation from drug administration varied from 1.6 minutes to 15 minutes.
  • Proportion of people with recurrence of seizures ranged from 10.4% to 19.1% in two trials reporting this outcome.
  • Across trials, rates of respiratory depression among participants receiving active treatments were generally low (from 6.4% to 10.6%).
  • Mortality rate ranged from 2% to 7.6% in active treatment groups and from 6.2% to 15.5% in control groups.

National Institute for Health Research