Status epilepticus: lorazepam or diazepam helped stop fitting out of hospital

Clinical bottom line (level 1b)

  1. Patients with status epilepticus occuring out-of-hospital who received diazepam compared with placebo were more likely to stop fitting (NNT = 5 at minutes) .
  2. Patients who received lorazepam compared with placebo were more likely to stop fitting (NNT = 3 at minutes) .
  3. Lorazepam was not clearly more effective or safer than diazepam.
Allredge et al: N Engl J Med 2001; 345 : 631-637
Expires June 2004

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: city, USA

205 patients (aged mean 50, 63% male) with 258 episodes of status epilepticus diagnosed out of hospital

Excluded if
  • in police custody or transported by private ambulance company
  • pregnant
  • iv access unobtainable
  • pulse < 60 beat/min
  • systolic bp < 100 mmHg
  • 2nd or 3rd degree AV block, sustained VT
  • asthma or COPD
  • history of long-term use of or sensitivity to benzodiazepines

Control Group: (n = 85, 85 analysed): placebo
Experimental Group: (n = 91, 91 analysed): diazepam 5 mg iv over 1 to 2 minutes
Experimental Group: (n = 82, 82 analysed): lorazepam 2 mg iv over 1 to 2 minutes
Patients could receive an additional injection if seizures recurred or contined for 4 minutes or more
100% followed for ? minutes

The evidence

diazepam v. placebo
Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
status epilepticus terminated minutes 15
(21.1%)		 29
(42.7%)		 100%
(19% to 240%)		 21.5%
(6.41% to 36.6%)		 5
(3 to 16)

lorazepam v. placebo
Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
status epilepticus terminated minutes 15
(21.1%)		 39
(59.1%)		 180%
(71% to 360%)		 38.0%
(22.7% to 53.2%)		 3
(2 to 4)

lorazepam v. diazepam
Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
status epilepticus terminated minutes 29
(42.7%)		 39
(59.1%)		 39%
(-1% to 95%)		 16.4%
(-0.256% to 33.1%)		 6
(NNT = 3 to infinity;
NNH = 390 to infinity)

  • No significant difference was noted in out-of-hospital complication rates, the outcome following treatment in the emergency department or neurological outcome on discharge from hospital for any group.

Comments

  1. The study was too small to show any differences between lorazepam and diazepam.

Citation

  1. Allredge BK, Gelb AM, Isaacs SM, et al: a comparison of lorazepam, diazepam and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001; 345 : 631-637
Search Terms: from ACP Journal Club
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient out-of-hospital status epilepticus
Intervention or Exposure diazepam or lorazepam
Comparison placebo
Outcome stopped fitting, complications