Two drugs used to treat epileptic seizures in children appear to provide equal effectiveness and safety, according to a new study published in the April 23 Journal of the American Medical Association (JAMA). In a comparison study, researchers found that lorazepam (Ativan) — thought to be more effective than diazepam (Valium) — was no better for stopping seizures.
A JAMA news release reports that prolonged epileptic seizures, known as “status epilepticus,” occur in U.S. children 10,000 times each year. Rapid control of these seizures is essential to avoid permanent injury and life-threatening complications, including respiratory failure.
Because Ativan and Valium are frequently given in emergency situations, a research team led by James M. Chamberlain, MD, of the Children’s National Medical Center in Washington, D.C., randomly assigned 273 patients to receive either Ativan or Valium intravenously. The patients were ages 3 months to younger than 18 years and had been seen at one of 11 pediatric emergency departments. Of the 273 children in the study, 140 received Valium and 133 received Ativan.
Study results showed that 72.1 percent of the children who received Valium ceased having a seizure within 10 minutes of getting the drug and did not have another seizure within 30 minutes. Of the group that got Ativan, 72.9 percent had the same results. In each group, 26 patients required help breathing, a measure of safety taken into consideration by the researchers.
There were no other significant differences in other outcomes, including rates of seizure recurrences and the time it took for the seizure to end. However, it was noted that patients who took Ativan were more likely to be sedated (67 percent) than those who received Valium (50 percent).
“Unexpectedly, Ativan is not superior to Valium for treating pediatric seizures. It’s been dogma in medicine that Ativan is better than Valium, but this study shows they are just about equal,” Chamberlain told HealthDay.
Chamberlain indicated that because a prolonged seizure in a child is an emergency, Valium, which does not have to be refrigerated, might be a better choice for paramedics because it can be administered before the child reaches the hospital. “They can start Valium without having a refrigerator and feel comfortable they are giving a good medicine,” explained Chamberlain. “Also, parents have a form of rectal Valium they can give rapidly at home.”
Michael S. Duchowny, MD, a pediatric neurologist and director of the Epilepsy Center at Miami Children’s Hospital, underscored the significance of the findings. “This paper is important because Valium is much more widely available, so that it is equal to Ativan is important.”
“These drugs are used in emergency situations, so if you can get of them, they are both effective, but you don’t have to feel Valium is less effective,” added Duchowny, who was not involved in the study.
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