What do systematic reviews say?

Diazepam gel vs Placebo gel

Diazepam gel probably leads to lower non‐cessation of seizures compared with placebo gel (moderate certainty).

• Anticonvulsant therapy for status epilepticus 2014 · Cochrane Headline outcomes only
  RR 0.43 [0.3, 0.62]
  2 studies · 165 participants
  Moderate

Benzodiazepines (lorazepam) vs diazepam

Summary of findings ‐ Lorazepam showed no clear difference in seizure cessation compared with diazepam (low certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1.08 [0.98, 1.2]
  3 studies · 439 participants
  Low

Summary of findings ‐ Buccal midazolam vs intravenous diazepam

Summary of findings ‐ Buccal midazolam showed no clear difference in seizure cessation compared with intravenous diazepam (high certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 0.91 [0.8, 1.03]
  1 study · 120 participants
  High

Summary of findings ‐ Intranasal midazolam vs intravenous diazepam

Summary of findings ‐ Intranasal midazolam showed no clear difference in seizure cessation compared with intravenous diazepam (moderate certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 0.98 [0.91, 1.06]
  2 studies · 122 participants
  Moderate

Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam

Summary of findings ‐ Intramuscular midazolam showed no clear difference in seizure cessation compared with intravenous diazepam (low certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 0.97 [0.87, 1.09]
  2 studies · 105 participants
  Low

Summary of findings ‐ Intramuscular midazolam vs rectal diazepam

Summary of findings ‐ Intramuscular midazolam showed no clear difference in seizure cessation compared with rectal diazepam (moderate certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1.02 [0.93, 1.12]
  1 study · 100 participants
  Moderate

Intravenous midazolam vs intravenous diazepam

Summary of findings ‐ Intravenous midazolam showed no clear difference in seizure cessation compared with intravenous diazepam (moderate certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1.08 [0.97, 1.21]
  1 study · 80 participants
  Moderate

Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam

Lorazepam IV probably leads to lower non‐cessation of seizures compared with diazepam IV (moderate certainty).

• Anticonvulsant therapy for status epilepticus 2014 · Cochrane Headline outcomes only
  RR 0.64 [0.45, 0.9]
  3 studies · 264 participants
  Moderate

Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination

Lorazepam IV showed no clear difference in non‐cessation of seizures compared with diazepam plus phenytoin IV (low certainty).

• Anticonvulsant therapy for status epilepticus 2014 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 370 participants
  Low

Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination

Summary of findings ‐ Intravenous lorazepam showed no clear difference in seizure cessation: within 10 minutes compared with intravenous diazepam/intravenous phenytoin combination (moderate certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1 [0.98, 1.02]
  1 study · 178 participants
  Moderate

Summary of findings ‐ Intranasal midazolam vs rectal diazepam

Summary of findings ‐ Intranasal midazolam showed no clear difference in seizure cessation: within 10 minutes compared with rectal diazepam (low certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1.47 [1, 2.16]
  1 study · 45 participants
  Low

Summary of findings ‐ Buccal midazolam vs rectal diazepam

It is very uncertain whether summary of findings ‐ Buccal midazolam changes seizure cessation: within 5 minutes to 1 hour compared with rectal diazepam (very low certainty).

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  RR 1.25 [1.13, 1.38]
  4 studies · 648 participants
  Very low

Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam

• Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children 2018 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 105 participants
  Very low