Midazolam vs Lorazepam for Status Epilepticus
This meta-analysis included 4 randomized controlled trials looking at midazolam versus lorazepam for pediatric patients with status epilepticus. There were 3 ED-focused papers and 1 pre-hospital paper.
Primary endpoints were:
1) the rate of treatment success in achieving seizure cessation
2) the rate of treatment failure in achieving seizure cessation
3) the time to seizure cessation from drug administration
4) respiratory depression and need for intubation
Secondary endpoints were:
1) time to drug administration from hospital arrival
2) time to seizure cessation from hospital arrival
3) seizure recurrence
4) need for rescue medications
What did they find:
Not much. There was no statistically significant difference in any primary endpoint between the two medications. However, they were able to perform a subgroup analysis to look at route of administration and this is where there was some notable difference, specifically in the "from hospital arrival" endpoints. Intranasal midazolam was able to be administered about 3-4 minutes quicker than IV lorazepam, which was reflected in seizure cessation about 3 minutes faster as well.
Bottom Line: Get your preferred benzo on board as quickly as possible. While this study shows no significant difference between the 2 groups in rate of seizure cessation, time from medication administration to seizure cessation, and adverse events, it does show that generally we can get IN midazolam in the quickest.
Primary endpoints were:
1) the rate of treatment success in achieving seizure cessation
2) the rate of treatment failure in achieving seizure cessation
3) the time to seizure cessation from drug administration
4) respiratory depression and need for intubation
Secondary endpoints were:
1) time to drug administration from hospital arrival
2) time to seizure cessation from hospital arrival
3) seizure recurrence
4) need for rescue medications
What did they find:
Not much. There was no statistically significant difference in any primary endpoint between the two medications. However, they were able to perform a subgroup analysis to look at route of administration and this is where there was some notable difference, specifically in the "from hospital arrival" endpoints. Intranasal midazolam was able to be administered about 3-4 minutes quicker than IV lorazepam, which was reflected in seizure cessation about 3 minutes faster as well.
Bottom Line: Get your preferred benzo on board as quickly as possible. While this study shows no significant difference between the 2 groups in rate of seizure cessation, time from medication administration to seizure cessation, and adverse events, it does show that generally we can get IN midazolam in the quickest.
