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Treatment of Status Epilepticus With Lorazepam

Treatment of Status Epilepticus With Lorazepam Abstract • Twenty-one episodes of status epilepticus (SE) were each treated with 1 to 9 mg (mean, 4 mg) of intravenous lorazepam. All patients with generalized tonicclonic (GTC) SE responded within 15 minutes. Nine (82%) of the 11 patients with episodes of partial SE with altered responsiveness responded poorly. Respiratory depression occurred in five instances (two requiring intubation) and was associated with transient loss of brain-stem reflexes, hypotension, and decorticate posturing in three cases. Generalized tonic-clonic SE was transformed into partial SE with altered responsiveness in three patients. In an additional four patients, marked lethargy developed. Lorazepam appears effective in controlling GTC SE but only occasionally effective in partial SE with altered responsiveness. References 1. Delgado-Escueta AV, Bajorek JG: Status epilepticus: Mechanisms of brain damage and rational management . Epilepsia 1982;23( (suppl 1) ):S29-S41.Crossref 2. Treiman DM, Delgado-Escueta AV: Status epilepticus , in Thompson RA, Green JR (eds): Critical Care of Neurological and Neurosurgical Emergencies . New York, Raven Press, 1980, pp 53-99. 3. Chapman AG, Meldrum BS, Siesjö BK: Cerebral metabolic changes during prolonged epileptic seizures in rats . J Neurochem 1977; 28:1025-1035.Crossref 4. Meldrum BS, Horton RW, Brierley JB: Epileptic brain damage in adolescent baboons following seizures induced by allylglycine . Brain 1974;97:407-418.Crossref 5. Meldrum BS, Vigouroux RA, Brierley JB: Systemic factors and epileptic brain damage: Prolonged seizures in paralyzed artificially ventilated baboons . Arch Neurol 1973;29:82-87.Crossref 6. Rowan AJ, Scott DF: Major motor status epilepticus . Acta Neurol Scand 1970;46:573-584.Crossref 7. Whitty CWM, Taylor M: Treatment of status epilepticus . Lancet 1949;2:591-594.Crossref 8. Wasterlain CG, Plum F: Vulnerability of developing rat brain to electroconvulsive seizures . Arch Neurol 1973;29:38-45.Crossref 9. Duffy FH, Lombroso CT: Treatment of status epilepticus , in Klawans HL (ed): Clinical Neuropharmacology . New York, Raven Press, 1978, vol 3, pp 41-56. 10. Delgado-Escueta AV, Wasterlain C, Treiman DM, et al: Management of status epilepticus . N Engl J Med 1982;306:1337-1340.Crossref 11. Celesia GG: Modern concepts of status epilepticus . JAMA 1976;12:1571-1574.Crossref 12. Browne TR: Drug therapy reviews: Drug therapy of status epilepticus . Am J Hosp Pharm 1978;35:915-922. 13. Booker HE, Celesia GG: Serum concentrations of diazepam in subjects with epilepsy . Arch Neurol 1973;29:191-194.Crossref 14. Walker JE, Homan RW, Vasko MR, et al: Lorazepam in status epilepticus . Ann Neurol 1979;6:207-213.Crossref 15. Sorel L, Mechler L, Harmant J: Comparative trial of intravenous lorazepam and clonazepam in status epilepticus . Clin Ther 1981;4:326-336. 16. Amand G, Evard P: Injectable lorazepam in epilepsy . Rev Electroencephalogr Neurophysiol Clin 1976;6:532-533.Crossref 17. Abstracted , Epilepsy Abstracts , 1978, 11/158. 18. Waltregny A, Darjent J: Preliminary study of parenteral lorazepam in status epilepticus . Ada Neurol Belg 1975;75:219-229. 19. Griffith PA, Karp HR: Lorazepam in therapy for status epilepticus . Ann Neurol 1980; 7:493.Crossref 20. Pires de Oliveira RS: Treatment of convulsive seizure with a new benzodiazepine, lorazepam: Pilot study . Rev Bras Clin Ter 1978;7:415-422. 21. Leppik IE, Derivan AT, Homan RW et al: Double-blind study of lorazepam and diazepam in status epilepticus . JAMA 1983;249:1452-1454.Crossref 22. Gluckman MI, Stein L: Pharmacology of lorazepam . J Clin Psychiatry 1978;39:3-10. 23. Greenblatt DJ, Comer WH, Elliott HW, et al: Clinical pharmacokinetics of lorazepam: III. Intravenous injection . J Clin Pharmacol 1977; 17:490-494.Crossref 24. Ameer B, Greenblatt DJ: Lorazepam: A review of its clinical pharmacological properties and therapeutic uses . Drugs 1981;21:161-200.Crossref 25. Cormack RS, Milledge JS, Hanning CD: Respiratory effects and amnesia after premedication with morphine or lorazepam . Br J Anaesth 1977;49:351-361.Crossref 26. Elliott HW, Nomof N, Navarro G, et al: Central nervous system and cardiovascular effects of lorazepam in man . Clin Pharmacol Ther 1971;12:468-481. 27. Denaut M, Yernault JC, DeCoster A: Double-blind comparison of the respiratory effects of parenteral lorazepam and diazepam in patients with chronic obstructive lung disease . Curr Med Res Opin 1975;2:611-615.Crossref 28. Guerrero-Figueroa R, Guerrero-Figueroa E, Sneed GA, et al: Effects of lorazepam on CNS structures: Neurophysiological and behavioral correlations . Curr Ther Res 1974;16:137-146. 29. Browne TR, Penry JK: Benzodiazepines in the treatment of epilepsy . Epilepsia 1973;14:277-310.Crossref 30. Jaffe R, Christoff NJ: Intravenous diazepam in seizure disorders . Electroencephalogr Clin Neurophysiol 1967;23:77-97.Crossref 31. Laguna JF, Korein J: Diagnostic value of diazepam in electroencephalography . Arch Neurol 1972;26:265-272.Crossref 32. Pensky AL, Raff MC, Moore MJ, et al: Intravenous diazepam in the treatment of prolonged seizure activity . N Engl J Med 1967; 276:779-784.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Treatment of Status Epilepticus With Lorazepam

Archives of Neurology , Volume 41 (6) – Jun 1, 1984

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1984.04210080013006
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Abstract

Abstract • Twenty-one episodes of status epilepticus (SE) were each treated with 1 to 9 mg (mean, 4 mg) of intravenous lorazepam. All patients with generalized tonicclonic (GTC) SE responded within 15 minutes. Nine (82%) of the 11 patients with episodes of partial SE with altered responsiveness responded poorly. Respiratory depression occurred in five instances (two requiring intubation) and was associated with transient loss of brain-stem reflexes, hypotension, and decorticate posturing in three cases. Generalized tonic-clonic SE was transformed into partial SE with altered responsiveness in three patients. In an additional four patients, marked lethargy developed. Lorazepam appears effective in controlling GTC SE but only occasionally effective in partial SE with altered responsiveness. References 1. Delgado-Escueta AV, Bajorek JG: Status epilepticus: Mechanisms of brain damage and rational management . Epilepsia 1982;23( (suppl 1) ):S29-S41.Crossref 2. Treiman DM, Delgado-Escueta AV: Status epilepticus , in Thompson RA, Green JR (eds): Critical Care of Neurological and Neurosurgical Emergencies . New York, Raven Press, 1980, pp 53-99. 3. Chapman AG, Meldrum BS, Siesjö BK: Cerebral metabolic changes during prolonged epileptic seizures in rats . J Neurochem 1977; 28:1025-1035.Crossref 4. Meldrum BS, Horton RW, Brierley JB: Epileptic brain damage in adolescent baboons following seizures induced by allylglycine . Brain 1974;97:407-418.Crossref 5. Meldrum BS, Vigouroux RA, Brierley JB: Systemic factors and epileptic brain damage: Prolonged seizures in paralyzed artificially ventilated baboons . Arch Neurol 1973;29:82-87.Crossref 6. Rowan AJ, Scott DF: Major motor status epilepticus . Acta Neurol Scand 1970;46:573-584.Crossref 7. Whitty CWM, Taylor M: Treatment of status epilepticus . Lancet 1949;2:591-594.Crossref 8. Wasterlain CG, Plum F: Vulnerability of developing rat brain to electroconvulsive seizures . Arch Neurol 1973;29:38-45.Crossref 9. Duffy FH, Lombroso CT: Treatment of status epilepticus , in Klawans HL (ed): Clinical Neuropharmacology . New York, Raven Press, 1978, vol 3, pp 41-56. 10. Delgado-Escueta AV, Wasterlain C, Treiman DM, et al: Management of status epilepticus . N Engl J Med 1982;306:1337-1340.Crossref 11. Celesia GG: Modern concepts of status epilepticus . JAMA 1976;12:1571-1574.Crossref 12. Browne TR: Drug therapy reviews: Drug therapy of status epilepticus . Am J Hosp Pharm 1978;35:915-922. 13. Booker HE, Celesia GG: Serum concentrations of diazepam in subjects with epilepsy . Arch Neurol 1973;29:191-194.Crossref 14. Walker JE, Homan RW, Vasko MR, et al: Lorazepam in status epilepticus . Ann Neurol 1979;6:207-213.Crossref 15. Sorel L, Mechler L, Harmant J: Comparative trial of intravenous lorazepam and clonazepam in status epilepticus . Clin Ther 1981;4:326-336. 16. Amand G, Evard P: Injectable lorazepam in epilepsy . Rev Electroencephalogr Neurophysiol Clin 1976;6:532-533.Crossref 17. Abstracted , Epilepsy Abstracts , 1978, 11/158. 18. Waltregny A, Darjent J: Preliminary study of parenteral lorazepam in status epilepticus . Ada Neurol Belg 1975;75:219-229. 19. Griffith PA, Karp HR: Lorazepam in therapy for status epilepticus . Ann Neurol 1980; 7:493.Crossref 20. Pires de Oliveira RS: Treatment of convulsive seizure with a new benzodiazepine, lorazepam: Pilot study . Rev Bras Clin Ter 1978;7:415-422. 21. Leppik IE, Derivan AT, Homan RW et al: Double-blind study of lorazepam and diazepam in status epilepticus . JAMA 1983;249:1452-1454.Crossref 22. Gluckman MI, Stein L: Pharmacology of lorazepam . J Clin Psychiatry 1978;39:3-10. 23. Greenblatt DJ, Comer WH, Elliott HW, et al: Clinical pharmacokinetics of lorazepam: III. Intravenous injection . J Clin Pharmacol 1977; 17:490-494.Crossref 24. Ameer B, Greenblatt DJ: Lorazepam: A review of its clinical pharmacological properties and therapeutic uses . Drugs 1981;21:161-200.Crossref 25. Cormack RS, Milledge JS, Hanning CD: Respiratory effects and amnesia after premedication with morphine or lorazepam . Br J Anaesth 1977;49:351-361.Crossref 26. Elliott HW, Nomof N, Navarro G, et al: Central nervous system and cardiovascular effects of lorazepam in man . Clin Pharmacol Ther 1971;12:468-481. 27. Denaut M, Yernault JC, DeCoster A: Double-blind comparison of the respiratory effects of parenteral lorazepam and diazepam in patients with chronic obstructive lung disease . Curr Med Res Opin 1975;2:611-615.Crossref 28. Guerrero-Figueroa R, Guerrero-Figueroa E, Sneed GA, et al: Effects of lorazepam on CNS structures: Neurophysiological and behavioral correlations . Curr Ther Res 1974;16:137-146. 29. Browne TR, Penry JK: Benzodiazepines in the treatment of epilepsy . Epilepsia 1973;14:277-310.Crossref 30. Jaffe R, Christoff NJ: Intravenous diazepam in seizure disorders . Electroencephalogr Clin Neurophysiol 1967;23:77-97.Crossref 31. Laguna JF, Korein J: Diagnostic value of diazepam in electroencephalography . Arch Neurol 1972;26:265-272.Crossref 32. Pensky AL, Raff MC, Moore MJ, et al: Intravenous diazepam in the treatment of prolonged seizure activity . N Engl J Med 1967; 276:779-784.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Jun 1, 1984

References