Termination of seizures in the paediatric age group, best benzodiazepine and route of administration: A network meta‐analysis

• Published in: The European journal of neuroscience 2022-08, Vol.56 (3), p.4234-4245
• Main Authors: Hasan, Syed Umar, Pervez, Alina, Bhatty, Shaheen, Shamim, Shifa, Naeem, Aaima, Naseeb, Muhammad Wahdan
• Format: Article
• Language: English
• Subjects: benzodiazepine; Benzodiazepines; Clinical trials; Convulsions & seizures; Diazepam; Intravenous administration; Lorazepam; Meta-analysis; Midazolam; Patients; seizure; Seizures; status epilepticus
• ISSN: 0953-816X; 1460-9568
• DOI: 10.1111/ejn.15732

This network meta‐analysis aims to compare various benzodiazepines and their route of administration using the data published exclusively in randomized controlled trials (RCTs). Two thousand two hundred sixty‐three children presenting with an episode of seizure to ER or to a paramedic where they were administered a benzodiazepine as the first‐line treatment were included. All the outcomes were measured for their mean with 95% CI and rank probability. The primary outcome was the number of successful seizure cessation. Secondary outcomes were the time interval between drug administration and seizure cessation, the time interval between patient arrival and seizure cessation and the number of episodes of seizure recurrence after drug administration. For the number of successful cessations, intramuscular midazolam showed the highest mean and best rank probability with a value of .881 (.065) and 57.9%, respectively. For the time of cessation, both intravenous lorazepam (IVL) and intravenous diazepam showed a mean of 3.30 (1.30) with IVL having the highest rank probability of 32%. For total time for cessation, intranasal midazolam showed the best mean and rank probability with a value of 4.3 (1.1) and 55%, respectively. Buccal midazolam showed the lowest mean with a value of .106 (.084) for rate of recurrence. Although there was no significant difference between the treatments, but based on the rank probability, IVL shows more promising results for patients who already have an established intravenous line, and for patients presenting in the ER without an intravenous line, the first line of treatment should be INM as it shows the highest rank probability in total time with second‐highest successful cessation rate. Intravenous lorazepam should be used for patients with established IV access. Intranasal midazolam should be used for patients presenting to the ER for the first time. Intranasal midazolam provides a faster response time as it does not need an IV access.