Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus

• Published in: The New England journal of medicine Vol. 366; no. 7; pp. 591 - 600
• Main Authors: Silbergleit, Robert, Durkalski, Valerie, Lowenstein, Daniel, Conwit, Robin, Pancioli, Arthur, Palesch, Yuko, Barsan, William
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 16.02.2012
• Subjects: Adolescent; Adult; Anticonvulsants - administration & dosage; Anticonvulsants - adverse effects; Biological and medical sciences; Child; Child, Preschool; Children; Clinical trials; Consent; Convulsions; Data collection; Double-Blind Method; Drug dosages; Emergency medical care; Emergency Medical Services; Epilepsy; Federal regulation; Female; General aspects; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Hypnotics and Sedatives - administration & dosage; Infant; Infusions, Intravenous; Injections, Intramuscular; Intravenous administration; Intubation; Lorazepam; Lorazepam - administration & dosage; Lorazepam - adverse effects; Male; Medical sciences; Midazolam; Midazolam - administration & dosage; Midazolam - adverse effects; Middle Aged; Nervous system (semeiology, syndromes); Neurological diseases; Neurological disorders; Neurology; Pharmacy; R&D; Recurrence; Research & development; Seizures; Status Epilepticus - drug therapy; Stroke; Time Factors; Treatment Outcome; Medicine; Nervous system diseases; Prehospital period; Treatment; Intravenous administration; Subintrant crisis; Epilepsy; Central nervous system disease; Status epilepticus; Intramuscular administration; Comparative study; Cerebral disorder
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1107494

In this trial, subjects in status epilepticus were given either intramuscular midazolam or intravenous lorazepam by paramedics before arrival in the ER. Seizures were controlled in more subjects with midazolam, and midazolam was at least as safe and effective as lorazepam. Early termination of prolonged epileptic seizures in response to intravenous administration of benzodiazepines by paramedics in the prehospital setting is associated with better patient outcomes. The randomized, controlled Prehospital Treatment of Status Epilepticus (PHTSE) trial (ClinicalTrials.gov number, NCT00004297) compared diazepam, lorazepam, and placebo given intravenously by paramedics to treat subjects with prolonged convulsive seizures. 1 The trial showed that both these benzodiazepines were an effective prehospital treatment for seizures, as compared with placebo. The proportion of subjects whose seizures were terminated at the time of arrival in the emergency department was 59.1% in the group receiving intravenous lorazepam, 42.6% in the . . .