A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus

Alldredge, Brian K.; Gelb, Alan; Isaacs, S. Marshal; Corry, Megan; Allen, Faith; Ulrich, SueKay; Gottwald, Mildred D.; O'Neil, Nelda; Neuhaus, John; Segal, Mark R.; Lowenstein, Daniel H.

doi:10.1056/nejmoa002141

Cited by 804 publications

(654 citation statements)

References 17 publications

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“…First-line antiepileptic agents for patients with SE include lorazepam (0.1 mg/kg up to 4 mg per dose given at 5-10-min intervals), midazolam (10 mg intramuscularly), or diazepam (10 mg per rectum). First-line therapy will abort SE in roughly half of all patients [146]. All patients with convulsive SE should be given a second-line agent immediately after administration of the first-line agent in order to prevent further seizures.…”

Section: Seizuresmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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Section: Seizuresmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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“…Two different drugs were used: DZP and pentobarbital (PTB). DZP is often used clinically to stop seizures that have not stopped on their own after 5 minutes (22). PTB is commonly used to treat refractory SE (23).…”

Section: Introductionmentioning

confidence: 99%

Effective treatments of prolonged status epilepticus in developing rats

Hasson¹,

Kim²,

Moshé³

2008

Epilepsy & Behavior

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“…The first compared IV diazepam (5-10 mg), IV lorazepam (2-4 mg), and placebo, and found that patients who received either lorazepam or diazepam were more likely to have their SE terminated upon arrival to the emergency room than patients receiving placebo. 24 In addition, those receiving a benzodiazepine were less likely to experience respiratory compromise. The more recent Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) compared IV lorazepam (4 mg in adults, 2 mg in children) to intramuscular (IM) midazolam (10 mg in adults, 5 mg in children) and concluded that IM midazolam was at least as safe and effective for terminating SE in the prehospital setting.…”

Section: Treatment Of Generalized Convulsive Status Epilepticus Prehomentioning

confidence: 99%

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Betjemann

2015

Semin Neurol

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Status epilepticus (SE) represents a common neurologic emergency that if not treated appropriately and in a timely fashion can lead to significant neurologic injury and mortality. A heterogeneous disorder, SE is often organized into major categories, including generalized convulsive SE (GCSE), focal motor SE, nonconvulsive SE (NCSE), and refractory SE. The treatment of SE and outcomes are often dictated by which type of SE a patient is experiencing, the age of the patient, and the underlying etiology. Despite significant advances in research, practice patterns vary and controversy remains regarding the most appropriate treatment of the various forms of SE. Epidemiology and PrognosisWhen broadly defined as a seizure lasting more than 30 minutes or recurrent seizures with incomplete return to baseline, the annual incidence of SE ranges from 10 to 41 per 100,000 persons, or roughly 125,000 to 195,000 new cases annually in the United States. 1-5 These figures may even be underestimates, particularly in the case of NCSE, which is only diagnosed through electroencephalographic (EEG) monitoring; recent studies of inpatient EEG monitoring, particularly in the intensive care unit (ICU), have demonstrated high rates of electrographic seizures that likely are underrecognized. 6-11 Owing in part to this increase in SE detection in the hospital, the incidence of SE is increasing. 12,13 Although greatly influenced by the etiology, overall mortality estimates related to SE approach 20% 1 and are not changing dramatically over time. 12,13 When considering the causes of SE, it can be helpful to divide cases into acute and chronic etiologies. Acute symptomatic causes (i.e., stroke, metabolic, infectious, anoxic injury) tend to be more common than chronic causes (i.e., low antiepileptic drug level, alcohol abuse, tumor, remote effects from stroke) and are generally associated with a higher mortality. 2,5,14 Given the increasing Keywords ► seizures ► status epilepticus ► refractory status epilepticus ► epidemiology ► prehospital treatment ► diagnostic evaluation AbstractStatus epilepticus is a heterogeneous disorder with varied definitions and presentations. Taken together, all forms of status epilepticus carry significant morbidity and mortality, much of which is dictated by the underlying etiology. Generalized convulsive status epilepticus, which represents a common form, is a true neurologic emergency that requires emergent management. Treatment focuses on stabilizing the patient and aggressive medical management to achieve the timely termination of seizures. For other forms of status epilepticus including nonconvulsive and focal status epilepticus, the goal remains early seizure termination, but the use of intravenous medications should be weighed against the risks associated with these therapies. The diagnostic evaluation of status epilepticus is guided by the patient's history and should be broad, including a screen for toxins, electrolytes, structural abnormalities, and central nervous system infectious and autoimmune/inflam...

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A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus

Abstract: 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.

Cited by 804 publications

References 17 publications

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Effective treatments of prolonged status epilepticus in developing rats

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

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