ORLANDO, FLA. -- Intravenous midazolam was more effective than intravenous lorazepam for initial management of status epilepticus in pediatric patients in a prospective, randomized study comparing the two benzodiazepines.
There are scant data comparing the ability of benzodiazepines to terminate seizure activity in status epilepticus, Dr. Eileen M. McCormick noted at the annual meeting of the American Epilepsy Society.
Of 15 children aged 3 months to 16 years, randomized to receive midazolam when they presented to the emergency room with status epilepticus, 11 responded to the first dose of 0.2 mg/kg. Of the four who required a second dose of 0.1 mg/kg, three responded. One patient required endotracheal intubation following treatment, said Dr. McCormick, principal investigator of the study at Children's Hospital of Michigan and Wayne State University, Detroit.
Of 12 patients randomized to receive lorazepam, 8 responded after the first dose of 0.1 mg/kg, and none of the remaining 4 responded to a second dose of 0.05 mg/kg. Two patients in the lorazepam group required intubation following treatment, and one patient died due to overwhelming sepsis, Dr. McCormick said.
The overall response rate for midazolam after the second dose was 93%, compared with 67% for the lorazepam group, a statistically significant difference.
Mean pretreatment seizure duration was 56 minutes in the midazolam group and 45 minutes in the lorazepam group. That difference was not statistically significant, nor were there any significant differences in other patient characteristics, including seizure types. Seizures were categorized as generalized tonic-clonic in 11 midazolam patients and 9 lorazepam patients, anti as partial seizures in 4 midazolam patients and 3 lorazepam patients.
Patients in both of the study groups were treated according to a treatment algorithm to ensure that they all received the same standard of care while in the hospital, Dr. McCormick noted.
Both drugs offered similar safety profiles, but because midazolam was of superior efficacy in this study it warrants consideration as a first-line agent for managing status epilepticus, Dr. McCormick said.
Though the study did not address cost of the drugs, an audience member noted during the question and answer session that at the institution where she practices, midazolam costs nearly seven times as much as lorazepam, and both drugs are substantially more expensive than diazepam, which is also used to treat status epilepticus.
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