title: A Comparison of Midazolam, Lorazepam, and Diazepam for the Treatment of Status Epilepticus in Children: A Network Meta-analysis.
abstract: Midazolam, lorazepam, and diazepam were recommended as emergent initial therapy for status epilepticus. However, there are no current studies to confirm the best agent for pediatric status epilepticus. We compared the efficacy of midazolam, lorazepam, and diazepam in treating pediatric status epilepticus using a network meta-analysis method. In total, 16 randomized controlled trials containing 1821 patients were included. Nonintravenous midazolam, intravenous lorazepam, and intravenous diazepam were more successful in achieving seizure cessation when compared with nonintravenous diazepam (odds ratio = 2.23, 95% credibility interval: 1.62, 3.10; odds ratio = 2.71, 95% credibility interval: 1.25, 5.89; odds ratio = 2.65, 95% credibility interval: 1.12, 6.29; respectively). Among lorazepam, midazolam, and diazepam, midazolam had the highest probability (surface under the cumulative ranking area [SUCRA] = 0.792) of achieving seizure cessation, and lorazepam had the largest probability (surface under the cumulative ranking area = 0.4346) of being the best treatment in reduction of respiratory depression. In conclusion, nonintravenous midazolam and intravenous lorazepam were superior to intravenous or nonintravenous diazepam, and intravenous lorazepam was at least as effective as nonintravenous midazolam in treating pediatric status epilepticus.
authors.affiliation: Department of Neurosurgery, Tianshui First People's Hospital, Tianshui, China zzyyhwiii@163.com.
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Zhao
authors.affiliation: Department of Respiratory, Tianshui First People's Hospital, Tianshui, China.
authors.forename: Hong-Ying
authors.initials: HY
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Tianshui First People's Hospital, Tianshui, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wen
authors.affiliation: Department of Neurosurgery, Tianshui First People's Hospital, Tianshui, China.
authors.forename: Zhi-Bo
authors.initials: ZB
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Tianshui First People's Hospital, Tianshui, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Feng
authors.affiliation: Evidence Based Medicine Center of Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
authors.forename: Jing-Chun
authors.initials: JC
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008140:Lorazepam / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use*; D013226:Status Epilepticus / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam
keywords: children; diazepam; lorazepam; midazolam; network meta-analysis; status epilepticus