Lorazepam vs. Diazepam for Pediatric Status Epilepticus: The PECARN Trial

In the April 23rd issue of the journal JAMA, Doctors Chamberlain and others in the Pediatric Emergency Care Applied Research Network, otherwise known as PECARN, present results of a randomized trial to assess the best first-line agent for pediatric status epilepticus. The investigators, utilizing a double-blind, randomized clinical trial conducted between March 1, 2008, and March 14, 2012, randomized patients who were between the age of 3 months to younger than 18 years with convulsive status epilepticus to one of 11 academic pediatric emergency departments. Enrollment consisted of 273 patients: 140 randomized to diazepam and 133 to lorazepam. Patients received either 0.2 mg/kg of diazepam or 0.1 mg/kg of lorazepam IV. Status epilepticus was defined in this trial as either:

1. Three or more convulsions within the preceding hour and currently experiencing a convulsion

2. Two or more convulsions in succession with no recovery of consciousness and currently experiencing a convulsion

3. A current single convulsion of at least five minutes duration

The primary success measure was cessation of status epilepticus by 10 minutes without recurrence within 30 minutes. The investigators found that cessation of status epilepticus for 10 minutes without recurrence within 30 minutes occurred in 72.1% of the diazepam group and 72.9% of the lorazepam group. Assisted ventilation was required by 26 patients in each group. There was no statistically significant difference in secondary outcomes except that lorazepam patients were more likely to be sedated. The authors concluded that among pediatric patients with convulsive status epilepticus treatment with lorazepam did not result in improved efficacy or safety compared with diazepam. There is no support for preferential use of lorazepam.