Management of acute convulsive seizures in adults and children (when no intravenous access is available)
Question 1: In adults and children with acute convulsive seizures in first level care or in the community (when no IV access is available), which antiepileptic drugs when compared to comparator produce benefits/harm in the specified outcomes?
- Population: adults and children with acute convulsive seizures when no IV access is available
- Interventions: antiepileptic drugs by non IV route
- diazepam [rectal, intramuscular]
- midazolam [intranasal, intramuscular, buccal]
- lorazepam [rectal, intranasal]
- paraldehyde [intramuscular]
- phenobarbital [intramuscular]
- Comparison:
- intravenous benzodiazepines (diazepam IV, lorazepam IV)
- one intervention versus other
- Outcomes:
- stopping seizure
- adverse effects.
Recommendation(s)
When IV access is not available, rectal diazepam should be administered for control of acute convulsive seizures.
Strength of recommendation: STRONG
IM administration of diazepam is not recommended because of erratic absorption.
Strength of recommendation: STRONG
IM phenobarbital may be considered as an option where rectal use of diazepam is not possible due to medical or social reasons.
Strength of recommendation: STANDARD