Treatment of Status Epilepticus With Lorazepam

Levy, Robert J.; Krall, Ronald L.

doi:10.1001/archneur.1984.04210080013006

Cited by 55 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Subsequently, in a doubleblind trial, Leppik et al (1983) found that seizures in status epilepticus were controlled in 89% of episodes treated with lorazepam and in 76% treated with diazepam; the times of onset of action and adverse effects did not differ between the drugs. More recently, Levy and Krall (1984) found lorazepam to be useful in generalised tonic-clonic status epilepticus, but only occasionally effective in partial status with altered responsiveness. Moffett and Scott (1984) studied 24 patients with drug-resistant epilepsy using 1 mg of oral lorazepam and placebo added to their pre-existing drug regime, in a double-blind cross-over design, each treatment agent being given for 6 weeks.…”

Section: The 1 Cbenzodiazepinesmentioning

confidence: 99%

Current Status of the 1,4‐ and 1,5‐Benzodiazepines in the Treatment of Epilepsy: The Place of Clobazam

Robertson

1986

Epilepsia

View full text Add to dashboard Cite

The 1,4-benzodiazepines have a recognised place in the treatment of epilepsy. Thus, diazepam, clonazepam, and, more recently, lorazepam are used intravenously for status epilepticus. Oral clonazepam has proved useful as adjunctive therapy in generalised absence seizures, myoclonic seizures, and partial seizures. Oral nitrazepam is well known for its use in the treatment of infantile spasms with hypsarrhythmia and in the myoclonic epilepsies of childhood. Clobazam, a 1,5-benzodiazepine, has been shown in controlled studies to be superior to placebo, and in open studies it has produced an overall reduction in seizure frequency of 65%. The main indication for its use is as oral adjunctive therapy in refractory epilepsy. It has a rapid onset of action, is well tolerated, and many studies indicate it has a psychotropic action and produces minimal or no cognitive impairment. The most common side-effect reported was sedation, while the overall incidence of side-effects in the open studies was 38%. In all studies reviewed, 4% of patients had to be withdrawn because of adverse reactions. In general, there are no significant interactions with other anticonvulsants, although changes in a few have been described. Withdrawal seizures can occur and require gradual termination of clobazam. The main disadvantage of clobazam is the development of tolerance, which develops in approximately 36% of patients, and there is no way of predicting in which patients or when the phenomenon is likely to occur. A dose of 20 to 30 mg at night is recommended, possibly commencing at 10 mg.

show abstract

Section: The 1 Cbenzodiazepinesmentioning

confidence: 99%

Current Status of the 1,4‐ and 1,5‐Benzodiazepines in the Treatment of Epilepsy: The Place of Clobazam

Robertson

1986

Epilepsia

View full text Add to dashboard Cite

show abstract

“…21 The response rate of generalized tonic-colonic SE to lorazepam is 85% to 89%. 22 It also appears to be the most effective treatment of postanoxic myoclonic status epilepticus and, thus, should be its first-line therapy. 23 Like lorazepam, midazolam is a benzodiazepine.…”

Section: Discussionmentioning

confidence: 99%

Management of Refractory Status Epilepticus in an Actively Dying Patient

Dulin¹,

Noreika²,

Coyne³

2014

Journal of Pain & Palliative Care Pharmacotherapy

View full text Add to dashboard Cite

No consensus guidelines exist for the treatment of refractory myoclonic status epilepticus or refractory myoclonus in the palliative care setting. Evidence-based guidelines for the general medical population are often neither practical nor applicable at the end of life. Many challenges, including medication availability, route of administration, monitoring, and work-up are all unique to the palliative care setting. Two patients with refractory myoclonus versus refractory myoclonic status epilepticus are described here, illustrating the challenges involved in treatment as well the need for further research for therapy in the palliative care setting.

show abstract

“…Lorazepam additionally leads to less respiratory depression [195] when compared to other BD and -most important for a sustained antiepileptic effect and the avoidance of recurrence of SE -it seems to bind in a semicovalent manner at the GABA A receptor site extending its effect up to about 24 hours despite falling blood levels [196][197][198][199]. The dominant role of LZP in the treatment of (NC)SE was definitively established by the hallmark multicentre prospective double-blind Veterans Affairs-Study published in the New England Journal of Medicine in 1998, comparing four different first-line regimens (phenytoin [PHT], diazepam followed by PHT, phenobarbital and LZP) where LZP showed to be significantly superior to PHT, but not to the other drugs; it was, however, easier to handle [20].…”

Section: S C H W E I Z E R a R C H I V F ü R N E U R O L O G I E U N mentioning

confidence: 99%