title: Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study.
abstract: OBJECTIVE
  Intravenous lorazepam is considered the drug of first choice for control of acute convulsive seizures. However, resource or personnel constraints necessitate the study of alternative routes and medications. This study compared the efficacy and adverse effects of intranasal versus intravenous lorazepam in children aged 6-14 years who presented with acute seizures.
  
  
  METHODS
  This was a randomized open-label study conducted at an Indian hospital from August 2008 to April 2009. One hundred forty-one consecutive children aged 6-14 years who presented convulsing to the emergency room were included. After stabilization, the children were randomized to receive either intravenous or intranasal lorazepam (0.1 mg/kg, maximum 4 mg). The primary outcome measure was clinical seizure remission within 10 min of drug administration. The study was registered with clinicaltrials.gov (NCT00735527).
  
  
  RESULTS
  Seventy patients were randomized to receive intravenous and 71 to receive intranasal lorazepam. The patients in the two groups were comparable at baseline. Clinical seizure remission within 10 min of drug administration was found in 80% of the intravenous group as compared to 83.1% of intranasal group. The lower limit of 95% confidence interval for effect size was approximately -9.7%, with an a priori cutoff for noninferiority of -10%.
  
  
  CONCLUSIONS
  Intranasal administration of lorazepam is not found to be inferior to intravenous administration for termination of acute convulsive seizures in children.
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Arya
authors.forename: Sheffali
authors.initials: S
authors.lastname: Gulati
authors.forename: Madhulika
authors.initials: M
authors.lastname: Kabra
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Sahu
authors.forename: Veena
authors.initials: V
authors.lastname: Kalra
mesh_terms: D000208:Acute Disease; D000281:Administration, Intranasal; D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam