A prospective, open, odd and even dates trial of lorazepam compared to diazepam for the treatment of acute convulsions and status epilepticus in 102 children is reported from the Royal Liverpool Children’s NHS Trust, UK. Lorazepam (0.05 - 0.1 mg/kg) and diazepam (0.3 - 0.4 mg/kg) controlled convulsions within 20 to 60 seconds in 76% and 51% of patients, respectively, after a single dose administered IV over 15 to 30 seconds. Multiple doses as well as additional AEDs were required in 17 patients who received an initial injection of diazepam compared to only 1 who received lorazepam. Respiratory depression occurred in 7 diazepam treated patients and necessitated admission to intensive care. No patient receiving lorazepam required intensive care. Rectal administration, when venous injection was not possible, was 100% effective with a single dose of lorazepam in 6 patients treated, whereas 13 of 19 patients receiving diazepam rectally required multiple doses, 12 required additional AEDs, 1 had respiratory depression, 2 were admitted to intensive care, and 7 relapsed with recurrence of seizures within 24 hours. [1]

COMMENT. Lorazepam appears to be safe, at least as effective as diazepam in the initial control of acute convulsions, including status epilepticus, and more effective in sustaining seizure control. Rectal lorazepam was useful in infants when intravenous injection was impractical. Lorazepam has a longer half life than diazepam, and its duration of action is more prolonged, accounting for the more sustained control. (See Progress in Pediatric Neurology I, 1991, PNB Publishers, pp124-5).