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Volume 345:631-637 August 30, 2001 Number 9 Next

	Full Text PDF Editorial by Valenzuela, T. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background It is uncertain whether the administration of benzodiazepines by paramedics is an effective and safe treatment for out-of-hospital status epilepticus.

Methods We conducted a randomized, double-blind trial to evaluate intravenous 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 diazepam (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 diazepam, and 71 received placebo. Status epilepticus had been terminated on arrival at the emergency department in more patients treated with lorazepam (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 group as compared with the placebo group was 4.8 (95 percent confidence interval, 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 complications after the study treatment was administered were 10.6 percent for the lorazepam group, 10.3 percent for the diazepam group, and 22.5 percent for the placebo group (P=0.08).

Conclusions Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.

Source Information

From the Departments of Clinical Pharmacy (B.K.A., M.D.G.), Neurology (B.K.A., F.A., D.H.L.), Surgery (S.M.I.), Epidemiology and Biostatistics (J.M.N., M.R.S.), and Emergency Services (A.M.G., S.M.I., N.O.), San Francisco General Hospital and the University of California, San Francisco; the Emergency Medical Services Division, San Francisco Fire Department, San Francisco (S.M.I., M.D.C.); and the Carondelet Health Network, Tucson, Ariz. (S.U.).

Address reprint requests to Dr. Lowenstein at Gordon Hall, Rm. 103, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, or at daniel_lowenstein{at}hms.harvard.edu.

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