Presented by: Gargi Mukherjee MD (PGY1)
Clinical questions:
- Is intranasal lorazepam (Ativan) as effective as intravenous lorazepam?
- Can intranasal lorazepam be used as a home rescue medication?
Conclusions of Arya, et al.:
- More studies required to investigate the effectiveness of intranasal lorazepam in treating acute seizures in the pediatric population.
- Initial studies show that it may be another option to consider in the future
- Need to compare to standard of care: currently rectal diazepam and IN midazolam
- Need to study the ease/feasibility of home use
Conclusions of Holsti, et al.:
- Intransal midazolam can be used as an alternative to rectal diazepam
- Consider offering this to families as an option for abortive seizure treatment inpatient when access is not available
- May be a better option for school or home as well
References:
Arya R, Gulati S, Kabra M, Sahu JK, Kalra V. Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia. 2011 Apr;52(4):788-93.
Ahmad S, Ellis JC, Kamwendo H, Molyneux E. Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: an open randomised trial. Lancet. 2006 May 13;367(9522):1591-7.
Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, Healy A, Firth S, Filloux F. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010 Aug;164(8) :747-53.
Bhattacharyya M, Kalra V, Gulati S. Intranasal midazolam vs rectal diazepam in acute childhood seizures. Pediatr Neurol. 2006 May;34(5):355-9.
Pediatric Focus 