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Benzodiazepines were as safe as and more effective than placebo for out-of-hospital status epilepticus

Design
Randomised {allocation concealed^*}, blinded {patients, clinicians, data collectors, and outcome assessors},^* placebo controlled trial with follow up to time of arrival at the emergency department.

Setting
San Francisco, California, USA.

Patients
205 patients (258 enrollments) who were 18 years of age (mean age 51 y, 63% men, 50% white) and had an out-of-hospital diagnosis of status epilepticus. Exclusion criteria included pulse < 60 beats/minute, systolic blood pressure < 100 mm Hg, and a history of long-term use of or sensitivity to benzodiazepines. Only data from the first enrollment of each patient was reported. {Follow-up was 100%.}

Intervention
Patients were allocated to intravenous injection of lorazepam, 2 mg (n=66); diazepam, 5 mg (n=68); or placebo (n=71), given over a 1 to 2 minute period and only during generalised tonic clonic seizure activity. If seizures recurred or continued 4 minutes after the first injection, an identical second injection was given. Open label . . . [Full text of this article]

Samuel Wiebe, MD, MSc

University of Western Ontario, London, Ontario, Canada