Abstract
The acute seizure in childhood is a medical emergency which is usually managed by benzodiazepines used as a first line of therapy. There are no strict guidelines of using intranasal lorazepam in India. Many paediatricians use it in an emergency situation as it is inexpensive, easy to administer and even treatment can be started at home. Very few studies are available to compare efficacy and safety of intravenous lorazepam with intranasal lorazepam in childhood seizure, though both routes have comparable pharmacokinetic profile. Intravenous lorazepam (0.1 mg/kg) is already recommended as a first-line treatment of acute childhood seizures in India. There are very few studies regarding the usefulness of intranasal lorazepam. With this background, we compared intranasal lorazepam with the more widely accepted intravenous lorazepam for control of acute seizure. To compare effectiveness and safety of intranasal and intravenous lorazepam in acute seizure in children aged 5-12 years. This is an analytical observational cross-sectional study involving patients with acute seizure who received lorazepam via either the intravenous or intranasal route. Formulation and dosage of lorazepam were the same in both routes. Distributions of patient groups according to sex, age, and weight were statistically not significant (p=0.42, p=0.391, and p=0.605, respectively). Time to control seizure within 10 min and persistent cessation of seizure activity were similar in both groups. Safety parameters showed no differences statistically. Though intravenous lorazepam is recommended as first-line treatment, intranasal lorazepam may be a good alternative choice in a convulsing child.
Highlights
The acute seizure in childhood is a medical emergency which is usually managed by benzodiazepines used as a first line of therapy
Acute seizures or convulsions are a common medical emergency in children worldwide with an overall annual incidence of 10-41 per 100 000.1 Acute seizure can cause unrelenting muscular activity leading to anaerobic metabolism and tissue breakdown as well as increase of the cerebral metabolic rate exceeding the oxygen and glucose supply to the brain leading to brain ischemia and neuronal death.[2]
Intravenous or intramuscular routes are usually preferred in a hospital set-up whereas other routes like intranasal route can be used in any situation even at home, school, road, etc
Summary
The acute seizure in childhood is a medical emergency which is usually managed by benzodiazepines used as a first line of therapy. There are no strict guidelines of using intranasal lorazepam in India Many paediatricians use it in an emergency situation as it is inexpensive, easy to administer and even treatment can be started at home. Intravenous lorazepam (0.1 mg/kg) is already recommended as a first-line treatment of acute childhood seizures in India. Aim: To compare effectiveness and safety of intranasal and intravenous lorazepam in acute seizure in children aged 5-12 years. It can be given intravenous or per rectally It acts rapidly but it is short acting, breakthrough seizures are common and can cause respiratory depression.[4,5] Intranasal midazolam is widely available, but it is short acting[6] and associated with seizure recurrence.[7]
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