Cochrane · systematic review · CD001905
Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children
McTague, A, Martland, T, Appleton, R · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
EpilepsyAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
72
current version
GRADE rated
52
No studies
20
Included studies
NR
No studies 20 · 27.8%Ungraded 0 · 0%Very low 4 · 5.6%Low 14 · 19.4%Moderate 29 · 40.3%High 5 · 6.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings ‐ Lorazepam compared with diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Lorazepam vs diazepam | RR 1.08 [0.98, 1.2] | 3 studies · 439 participants | Low Downgraded: risk of bias, inconsistency |
Time from drug administration to termination of seizures Summary of findings ‐ Lorazepam vs diazepam | no estimate extracted | 1 study · 80 participants | Moderate Downgraded: imprecision |
Incidence of respiratory depression Summary of findings ‐ Lorazepam vs diazepam | RR 0.72 [0.55, 0.93] | 3 studies · 439 participants | Moderate Downgraded: risk of bias |
Additional drugs required to terminate the seizure: additional dose of study drug Summary of findings ‐ Lorazepam vs diazepam | RR 0.88 [0.64, 1.2] | 3 studies · 439 participants | Low Downgraded: risk of bias, inconsistency |
Seizure recurrence within 24 hours Summary of findings ‐ Lorazepam vs diazepam | RR 0.86 [0.61, 1.2] | 3 studies · 439 participants | Moderate Downgraded: risk of bias |
Incidence of admissions to the ICU Summary of findings ‐ Lorazepam vs diazepam | RR 0.15 [0.02, 0.98] | 1 study · 86 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings ‐ Intranasal lorazepam compared with intramuscular paraldehyde
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation: within 10 minutes Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | RR 1.22 [0.99, 1.52] | 1 study · 160 participants | Moderate Downgraded: indirectness |
Time from drug administration to termination of seizures Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | no estimate extracted | NR | No studies |
Incidence of respiratory depression Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | no estimate extracted | 1 study · 160 participants | Low Downgraded: imprecision, indirectness |
Additional drugs required to terminate the seizure: 2 or more additional anticonvulsants required Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | RR 0.38 [0.18, 0.81] | 1 study · 160 participants | Low Downgraded: imprecision, indirectness |
Seizure recurrence within 24 hours Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | RR 0.73 [0.31, 1.71] | 1 study · 160 participants | Low Downgraded: imprecision, indirectness |
Incidence of admissions to the ICU Summary of findings ‐ Intranasal lorazepam vs intramuscular paraldehyde | no estimate extracted | NR | No studies |
Summary of findings ‐ Intravenous lorazepam compared with intravenous diazepam/intravenous phenytoin combination
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation: within 10 minutes Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | RR 1 [0.98, 1.02] | 1 study · 178 participants | Moderate Downgraded: indirectness |
Time from drug administration to stopping of seizures Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | no estimate extracted | 1 study · 178 participants | Moderate Downgraded: imprecision |
Incidence of respiratory depression Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | RR 0.78 [0.22, 2.82] | 1 study · 178 participants | Moderate Downgraded: imprecision |
Additional drugs required to stop the seizure Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | RR 0.42 [0.17, 1.04] | 1 study · 178 participants | Moderate Downgraded: imprecision |
Seizure recurrence within 24 hours Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | no estimate extracted | 1 study · 178 participants | Moderate Downgraded: indirectness |
Incidence of admissions to the ICU Summary of findings ‐ Intravenous lorazepam vs intravenous diazepam/intravenous phenytoin combination | no estimate extracted | NR | No studies |
Summary of findings ‐ Intravenous lorazepam compared with intranasal lorazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation: within 10 minutes Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | RR 1.07 [0.77, 1.49] | 1 study · 58 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Time from drug administration to stopping of seizures Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | no estimate extracted | 1 study · 58 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Incidence of respiratory depression Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | no estimate extracted | 1 study · 141 participants | Moderate Downgraded: imprecision, inconsistency, indirectness |
Additional drugs required to stop the seizure Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | no estimate extracted | NR | No studies |
Seizure recurrence within 24 hours Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | no estimate extracted | NR | No studies |
Incidence of admissions to the ICU Summary of findings ‐ Intravenous lorazepam vs intranasal lorazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Buccal midazolam compared with rectal diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation: within 5 minutes to 1 hour Summary of findings ‐ Buccal midazolam vs rectal diazepam | RR 1.25 [1.13, 1.38] | 4 studies · 648 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Time from drug administration to of seizures Summary of findings ‐ Buccal midazolam vs rectal diazepam | no estimate extracted | 2 studies · 141 participants | Low Downgraded: risk of bias, imprecision |
Incidence of respiratory depression Summary of findings ‐ Buccal midazolam vs rectal diazepam | RR 0.88 [0.61, 1.25] | 4 studies · 648 participants | Low Downgraded: risk of bias, imprecision |
Additional drugs required to stop the seizure: intravenous lorazepam required Summary of findings ‐ Buccal midazolam vs rectal diazepam | RR 0.58 [0.42, 0.79] | 1 study · 177 participants | Low Downgraded: risk of bias, imprecision |
Seizure recurrence within 24 hours Summary of findings ‐ Buccal midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Incidence of admissions to the ICU Summary of findings ‐ Buccal midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Buccal midazolam compared with intravenous diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Buccal midazolam vs intravenous diazepam | RR 0.91 [0.8, 1.03] | 1 study · 120 participants | High |
Time from drug administration to termination of seizures Summary of findings ‐ Buccal midazolam vs intravenous diazepam | no estimate extracted | 1 study · 120 participants | Moderate Downgraded: indirectness |
Incidence of respiratory depression Summary of findings ‐ Buccal midazolam vs intravenous diazepam | no estimate extracted | 1 study · 120 participants | High |
Additional drugs required to stop the seizure Summary of findings ‐ Buccal midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Seizure recurrence within 24 hours Summary of findings ‐ Buccal midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Incidence of admissions to the ICU Summary of findings ‐ Buccal midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Intranasal midazolam compared with intravenous diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | RR 0.98 [0.91, 1.06] | 2 studies · 122 participants | Moderate Downgraded: risk of bias |
Time from drug administration to stopping of seizures Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | no estimate extracted | 2 studies · 122 participants | Moderate Downgraded: indirectness |
Incidence of respiratory depression Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | no estimate extracted | 2 studies · 122 participants | High |
Additional drugs required to stop the seizure Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Seizure recurrence within 24 hours Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Incidence of admissions to the ICU Summary of findings ‐ Intranasal midazolam vs intravenous diazepam | no estimate extracted | 1 study · 52 participants | High |
Summary of findings ‐ Intranasal midazolam compared with rectal diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation: within 10 minutes Summary of findings ‐ Intranasal midazolam vs rectal diazepam | RR 1.47 [1, 2.16] | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Time from drug administration to termination of seizures Summary of findings ‐ Intranasal midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Incidence of respiratory depression Summary of findings ‐ Intranasal midazolam vs rectal diazepam | no estimate extracted | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Additional drugs required to stop the seizure Summary of findings ‐ Intranasal midazolam vs rectal diazepam | RR 0.32 [0.1, 1.03] | 1 study · 45 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Seizure recurrence within 24 hours Summary of findings ‐ Intranasal midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Incidence of admissions to the ICU Summary of findings ‐ Intranasal midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Intramuscular midazolam compared with intravenous diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | RR 0.97 [0.87, 1.09] | 2 studies · 105 participants | Low Downgraded: risk of bias, indirectness |
Time from drug administration to stopping of seizures: total time to seizure cessation Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | no estimate extracted | 2 studies · 105 participants | Very low Downgraded: risk of bias, indirectness |
Incidence of respiratory depression Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | no estimate extracted | 2 studies · 105 participants | Low Downgraded: risk of bias, indirectness |
Additional drugs required to terminate the seizure Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | RR 1.34 [0.35, 5.13] | 2 studies · 105 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Seizure recurrence within 24 hours: within one hour Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | RR 0.85 [0.27, 2.62] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Incidence of admissions to the ICU Summary of findings ‐ Intramuscular midazolam vs intravenous diazepam | no estimate extracted | 1 study · 81 participants | Moderate Downgraded: risk of bias |
Summary of findings ‐ Intramuscular midazolam compared with rectal diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | RR 1.02 [0.93, 1.12] | 1 study · 100 participants | Moderate Downgraded: risk of bias |
Time from drug administration to stopping of seizures Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | no estimate extracted | 1 study · 100 participants | Moderate Downgraded: risk of bias |
Incidence of respiratory depression Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | no estimate extracted | 1 study · 100 participants | Moderate Downgraded: risk of bias |
Additional drugs required to stop the seizure Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Seizure recurrence within 24 hours Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | no estimate extracted | 1 study · 100 participants | Moderate Downgraded: risk of bias |
Incidence of admissions to the ICU Summary of findings ‐ Intramuscular midazolam vs rectal diazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Intravenous midazolam compared with intravenous diazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | RR 1.08 [0.97, 1.21] | 1 study · 80 participants | Moderate Downgraded: risk of bias |
Time from drug administration to stopping of seizures Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | no estimate extracted | 1 study · 80 participants | Moderate Downgraded: imprecision |
Incidence of respiratory depression Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | RR 0.33 [0.01, 7.95] | 1 study · 80 participants | Moderate Downgraded: imprecision |
Additional drugs required to stop the seizure: additional dose of the trial drug required Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | RR 0.25 [0.03, 2.14] | 1 study · 80 participants | Moderate Downgraded: imprecision |
Seizure recurrence within 24 hours Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | RR 0.5 [0.1, 2.58] | 1 study · 80 participants | Moderate Downgraded: imprecision |
Incidence of admissions to the ICU Summary of findings ‐ Intravenous midazolam vs intravenous diazepam | no estimate extracted | NR | No studies |
Summary of findings ‐ Intravenous midazolam compared with intravenous lorazepam
Population: Children with acute tonic‐clonic seizures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Seizure cessation Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | RR 0.98 [0.91, 1.04] | 1 study · 80 participants | Moderate Downgraded: risk of bias |
Time from drug administration to termination of seizures Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | no estimate extracted | 1 study · 80 participants | Moderate Downgraded: imprecision |
Incidence of respiratory depression Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | no estimate extracted | 1 study · 80 participants | High |
Additional drugs required to terminate the seizure: additional dose of the trial drug required Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | RR 3 [0.13, 71.51] | 1 study · 80 participants | Moderate Downgraded: imprecision |
Seizure recurrence within 24 hours Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | RR 1 [0.15, 6.76] | 1 study · 80 participants | Moderate Downgraded: imprecision |
Incidence of admissions to the ICU Summary of findings ‐ Intravenous midazolam vs intravenous lorazepam | no estimate extracted | NR | No studies |