Click to goto CDHA Public Site Click to goto DivEMS Dal Public Site Click to goto EHS Nova Scotia

Pediatric Seizure

Date Last Search Run: Feb 01, 2022
Table last updated: May 02, 2021
Data last added: Mar 30, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)  
3 (weak evidence exists)      


Interventions

Diazepam-Buccal
Level Direction Primary Outcome Patient/Process Setting Reference

Diazepam-IM
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Duration of seizure Patient PH-Paramedic Seinfeld S., Shinnar S., Sun S., et al. Emergency management of febrile status epilepticus: Results of the FEBSTAT study. Epilepsia 2014; 55(3):388-395. Medline

Diazepam-IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Cessation Patient Appleton R., Martland T., Phillips B. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. The Cochrane Database of Systematic Reviews 2002; (4). Medline
I Supportive (Green) Time from arrival at hospital to starting treatment Patient ED-MD Lahat E., Goldman M., et al. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study BMJ 2000; 32:83-86 Medline
I Supportive (Green) Time to seizure cessation Patient ED-MD McMullan JT. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic Emerg Med 2010; (17):575. Medline
I Supportive (Green) Termination of seizure Patient Wu W., Zhang L., Xue R. Lorazepam or diazepam for convulsive status epilepticus: A meta-analysis. J Clin Neurosci 2016; 29:133-138. Medline
II Supportive (Green) Length of seizure Patient PH-Paramedic Alldredge BK., Wall DB., Ferriero DM. Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatr Neurol 1995; 12:213-6. Medline
II Supportive (Green) Time to cessation Process Appleton R., Sweeney A., Choonara I., et al. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Developmental Med and Child Neurology 1995; 37:682-8. Medline
II Supportive (Green) Feasibility, effectiveness and safety, termination of seizure Patient PH-Paramedic Dieckmann RA. Rectal diazepam for prehospital pediatric status epilepticus. Ann Emerg Med 1994; 23:216-24. Medline
II Supportive (Green) Time to seizure cessation Patient ED-MD Mahmoudian T., Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav 2004; 5(2):253-5. Medline
II Supportive (Green) Cessation of seizure Patient PH-Paramedic Rainbow J., Browne GJ., Lam LT. Controlling seizures in the prehospital setting: Diazepam or midazolam? Journal of Paedtrics and Child Health 2002; 38:582-6. Medline
II Supportive (Green) Duration of seizure Patient PH-Paramedic Seinfeld S., Shinnar S., Sun S., et al. Emergency management of febrile status epilepticus: Results of the FEBSTAT study. Epilepsia 2014; 55(3):388-395. Medline
II Neutral (Yellow) Occurrence of apnea Patient PH-Paramedic Bosson N., Khodabakhsh D., Kaji AH., Lee J., Squire B., Gausche-Hill M. Risk factors for apnea in children presenting with out-of-hospital seizure. Pediatr Emerg Care 2014; 30(9):617-20. Medline
III Neutral (Yellow) Time to cessation Patient ED-MD Chamberlain JM., Altieri MA., Futterman C., et al. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care 1997; 13:92-4. Medline
III Neutral (Yellow) Rates of ETI Process ED-MD Chiulli DA., Terndrup TE., Kanter RK. The influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus. J Emerg Med 1991; 9:13-7. Medline
III Neutral (Yellow) Rate of ETI Process PH-Paramedic Galustyan SG., Walsh-Kelly CM., Szewczuga D., Bergholte J., Hennes H. The short-term outcome of seizure management by prehospital personnel. Ped Emerg Care 2003; 19:221-5. Medline
III Opposes (Red) Incidence of ETI Patient ED-MD Orr RA., Dimand RJ., Venkataraman ST., et al. Diazepam and intubation in emergency treatment of seizures in children. Ann Emerg Med 1991; 20:1009-13. Medline

Diazepam-PR
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Cessation Patient Appleton R., Martland T., Phillips B. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. The Cochrane Database of Systematic Reviews 2002; (4). Medline
I Supportive (Green) Time to seizure cessation Patient ED-MD McMullan JT. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic Emerg Med 2010; (17):575. Medline
I Supportive (Green) Efficacy and adverse effects Patient In-Patient Scott RC., Besag FM., Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 1999; 353(9153):623-6. Medline
I Neutral (Yellow) Therapeutic success Patient ED-MD McIntyre J., Robertson S., Norris E., et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366(948):205-10. Medline
II Supportive (Green) Length of seizure Patient PH-Paramedic Alldredge BK., Wall DB., Ferriero DM. Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatr Neurol 1995; 12:213-6. Medline
II Supportive (Green) Time to cessation Process Appleton R., Sweeney A., Choonara I., et al. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Developmental Med and Child Neurology 1995; 37:682-8. Medline
II Supportive (Green) Resolving seizure activity. Patient OR Baysun S., Aydin OF., Atmaca E., Gurer YK. A comparison of buccal midazolam and rectal diazepam for the acute treatment of seizures. Clin Pediatr (Phila) 2005; 44(9):771-6. Medline
II Supportive (Green) Feasibility, effectiveness and safety, termination of seizure Patient PH-Paramedic Dieckmann RA. Rectal diazepam for prehospital pediatric status epilepticus. Ann Emerg Med 1994; 23:216-24. Medline
II Supportive (Green) Cessation of seizure Patient PH-Paramedic Rainbow J., Browne GJ., Lam LT. Controlling seizures in the prehospital setting: Diazepam or midazolam? Journal of Paedtrics and Child Health 2002; 38:582-6. Medline
II Supportive (Green) Efficacy and adverse event Patient PH-Paramedic Warden CR., Frederick C. Midazolam and Diazepam for Pediatric Seizures in the Prehospital Setting. Prehosp Emer Care 2006; 10:4:463-7. Medline
II Neutral (Yellow) Seizure termination Patient PH-Paramedic Chin RF., Neville BG., Peckham C., Wade A., Bedford H., Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: A prospective, population-based study. Lancet Neurol 2008; 7(8):696-703. Medline
II Neutral (Yellow) 1) Time to seizure resolution 2)Presence of a seizure in the ED Patient PH-Paramedic Holsti M., Sill BL., Firth SD., Filloux FM., Joyce SM., Furnival RA. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatric Emergency Care 2007; 23(3):148-153. Medline
II Opposes (Red) Occurrence of apnea Patient PH-Paramedic Bosson N., Khodabakhsh D., Kaji AH., Lee J., Squire B., Gausche-Hill M. Risk factors for apnea in children presenting with out-of-hospital seizure. Pediatr Emerg Care 2014; 30(9):617-20. Medline
III Supportive (Green) Seizure cessation Patient ED-MD Sykes RM., Okonofua JA. Rectal diazepam solution in the treatment of convulsions in the children's emergency room. Ann Trop Paediatr 1988; 8(4):259-261. Medline
III Neutral (Yellow) Rate of ETI Process PH-Paramedic Galustyan SG., Walsh-Kelly CM., Szewczuga D., Bergholte J., Hennes H. The short-term outcome of seizure management by prehospital personnel. Ped Emerg Care 2003; 19:221-5. Medline

IV access
Level Direction Primary Outcome Patient/Process Setting Reference

Lorazepam-Buccal
Level Direction Primary Outcome Patient/Process Setting Reference

Lorazepam-IM
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Duration of seizure Patient PH-Paramedic Seinfeld S., Shinnar S., Sun S., et al. Emergency management of febrile status epilepticus: Results of the FEBSTAT study. Epilepsia 2014; 55(3):388-395. Medline

Lorazepam-IN
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Seizure cessation within 10 minutes Patient ED-MD Ahmad S., Ellis JC., Kamwendo H., Molyneux E. Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: An open randomised trial. Lancet 2006; 367(9522):1591-7. Medline

Lorazepam-IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Cessation Patient Appleton R., Martland T., Phillips B. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. The Cochrane Database of Systematic Reviews 2002; (4). Medline
I Supportive (Green) Termination of seizure Patient PH-Paramedic Silbergleit R., Durkalski V., Lowenstein D., Conwit R., Pancioli A., Palesch Y., et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366(7):591-600. Medline
I Supportive (Green) Termination of seizure Patient Wu W., Zhang L., Xue R. Lorazepam or diazepam for convulsive status epilepticus: A meta-analysis. J Clin Neurosci 2016; 29:133-138. Medline
II Supportive (Green) Time to cessation Process Appleton R., Sweeney A., Choonara I., et al. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Developmental Med and Child Neurology 1995; 37:682-8. Medline
II Supportive (Green) Seizure termination Patient PH-Paramedic Chin RF., Neville BG., Peckham C., Wade A., Bedford H., Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: A prospective, population-based study. Lancet Neurol 2008; 7(8):696-703. Medline
II Supportive (Green) Duration of seizure Patient PH-Paramedic Seinfeld S., Shinnar S., Sun S., et al. Emergency management of febrile status epilepticus: Results of the FEBSTAT study. Epilepsia 2014; 55(3):388-395. Medline
III Supportive (Green) Rates of ETI Process ED-MD Chiulli DA., Terndrup TE., Kanter RK. The influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus. J Emerg Med 1991; 9:13-7. Medline
III Supportive (Green) Effectiveness Patient PH-Paramedic Welch RD., Nicholas K., Durkalski-Mauldin VL., et al. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 2015; 56(2):254-262. Medline

Lorazepam-PR
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Cessation Patient Appleton R., Martland T., Phillips B. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. The Cochrane Database of Systematic Reviews 2002; (4). Medline
II Supportive (Green) Time to cessation Process Appleton R., Sweeney A., Choonara I., et al. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Developmental Med and Child Neurology 1995; 37:682-8. Medline

Midazolam-Buccal
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Therapeutic success Patient ED-MD McIntyre J., Robertson S., Norris E., et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 2005; 366(948):205-10. Medline
I Supportive (Green) Time to seizure cessation Patient ED-MD McMullan JT. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic Emerg Med 2010; (17):575. Medline
I Supportive (Green) Efficacy and adverse effects Patient In-Patient Scott RC., Besag FM., Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 1999; 353(9153):623-6. Medline

Midazolam-IM
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time to seizure cessation Patient ED-MD McMullan JT. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic Emerg Med 2010; (17):575. Medline
I Supportive (Green) Termination of seizure Patient PH-Paramedic Silbergleit R., Durkalski V., Lowenstein D., Conwit R., Pancioli A., Palesch Y., et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366(7):591-600. Medline
II Supportive (Green) Cessation of seizure Patient PH-Paramedic Rainbow J., Browne GJ., Lam LT. Controlling seizures in the prehospital setting: Diazepam or midazolam? Journal of Paedtrics and Child Health 2002; 38:582-6. Medline
II Supportive (Green) Effectiveness Patient PH-Paramedic Vilke GM., Sharieff GQ., Marino A., Gerhart AE., Chan TC. Midazolam for the treatment of out-of-hospital pediatric seizures. Prehosp Emerg Care 2002; 6(2):215-217. Medline
II Supportive (Green) Efficacy and adverse event Patient PH-Paramedic Warden CR., Frederick C. Midazolam and Diazepam for Pediatric Seizures in the Prehospital Setting. Prehosp Emer Care 2006; 10:4:463-7. Medline
II Opposes (Red) Occurrence of apnea Patient PH-Paramedic Bosson N., Santillanes G., Kaji AH., Fang A., Fernando T., Huang M., Gausche-Hill M. Risk factors for apnea in pediatric patients transported by paramedics for out-of-hospital seizure. Annals of Emergency Medicine 2014; 63(3):302-8. Medline
III Supportive (Green) Time to cessation Patient ED-MD Chamberlain JM., Altieri MA., Futterman C., et al. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care 1997; 13:92-4. Medline
III Supportive (Green) Effectiveness Patient PH-Paramedic Welch RD., Nicholas K., Durkalski-Mauldin VL., et al. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 2015; 56(2):254-262. Medline

Midazolam-IN
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time from arrival at hospital to starting treatment Patient ED-MD Lahat E., Goldman M., et al. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study BMJ 2000; 32:83-86 Medline
I Supportive (Green) Time to seizure cessation Patient ED-MD McMullan JT. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic Emerg Med 2010; (17):575. Medline
I Supportive (Green) Cessation of seizures Patient ED-MD Thakker A., Shanbag P. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol 2013; 260(2):470-474. Medline
II Supportive (Green) 1) Time to seizure resolution 2)Presence of a seizure in the ED Patient PH-Paramedic Holsti M., Sill BL., Firth SD., Filloux FM., Joyce SM., Furnival RA. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatric Emergency Care 2007; 23(3):148-153. Medline
II Supportive (Green) Time to seizure cessation Patient ED-MD Mahmoudian T., Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav 2004; 5(2):253-5. Medline
II Neutral (Yellow) Redosing Patient PH-Paramedic Whitfield D, Bosson N, Kaji AH, Gausche-Hill M. The Effectiveness of Intranasal Midazolam for the Treatment of Prehospital Pediatric Seizures: A Non-inferiority Study. Prehosp Emerg Care 2021:1-9. Medline
II Opposes (Red) Occurrence of apnea Patient PH-Paramedic Bosson N., Santillanes G., Kaji AH., Fang A., Fernando T., Huang M., Gausche-Hill M. Risk factors for apnea in pediatric patients transported by paramedics for out-of-hospital seizure. Annals of Emergency Medicine 2014; 63(3):302-8. Medline
III Supportive (Green) Acceptability Process In-Patient Harbord MG., Kyrkou NE., Kyrkou MR., et al. Use of intranasal midazolam to treat acute seizures in paediatric community settings. Paediatr. Child Health 2004; 40:556-8. Medline

Midazolam-IV
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Cessation of seizure Patient PH-Paramedic Rainbow J., Browne GJ., Lam LT. Controlling seizures in the prehospital setting: Diazepam or midazolam? Journal of Paedtrics and Child Health 2002; 38:582-6. Medline
II Supportive (Green) Effectiveness Patient PH-Paramedic Vilke GM., Sharieff GQ., Marino A., Gerhart AE., Chan TC. Midazolam for the treatment of out-of-hospital pediatric seizures. Prehosp Emerg Care 2002; 6(2):215-217. Medline
II Opposes (Red) Occurrence of apnea Patient PH-Paramedic Bosson N., Santillanes G., Kaji AH., Fang A., Fernando T., Huang M., Gausche-Hill M. Risk factors for apnea in pediatric patients transported by paramedics for out-of-hospital seizure. Annals of Emergency Medicine 2014; 63(3):302-8. Medline
III Neutral (Yellow) Need for second dose Patient PH-Paramedic Guterman EL, Sanford JK, Betjemann JP, Zhang L, Burke JF, Lowenstein DH, et al. Prehospital midazolam use and outcomes among patients with out-of-hospital status epilepticus. Neurology 2020; 95(24):e3203-12. Medline

Point of Care Blood Glucose Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
II Opposes (Red) Time to benzodiazepine administration Process PH-Paramedic Beskind DL., Rhodes SM., Stolz U., et al. When should you test for and treat hypoglycemia in prehospital seizure patients? Prehosp Emerg Care 2014; 18(3):433-41. Medline
III Neutral (Yellow) Compliance Process PH-Paramedic Burroughs ZT, Mitchell MS, Hiestand B, Winslow J. Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study. Academic emergency medicine 2019. Medline
III Opposes (Red) Prevalence of hypoglycemia Process Remick K., Redgate C., Ostermayer D., Kaji AH., Gausche-Hill M. Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management. Prehosp Emerg Care 2017; 21(2):216-21. Medline


[ PEP Database - Table of Contents ] [ Email: PEP@Dal.ca ]