Ali S. Raja, MD, MBA, MPH, FACEP reviewing Alshehri A et al. Acad Emerg Med 2017 Mar 25.

A meta-analysis found that seizures were controlled more quickly when benzodiazepines were administered via non-intravenous routes, due mostly to the time necessary to place an IV line.

Benzodiazepines remain the first-line treatment for patients in status epilepticus. However, administering them via intravenous (IV) line obviously requires the placement of said line, which can lead to delays. In both the prehospital and emergency department settings, where IV access has yet to be established, other routes of administration are often used. These researchers performed a systematic review and meta-analysis of studies comparing IV benzodiazepines with non-IV benzodiazepines (administered buccally, rectally, intranasally, or intramuscularly), focusing on failure rates, time to seizure control, and complications.

A total of 11 studies (with a combined total of 1633 patients, both children and adults) were included in the meta-analysis. The studies were widely heterogeneous and the analysis was skewed by one large randomized controlled trial. Nevertheless, the pooled results showed that non-IV benzodiazepine administration was associated with a lower treatment failure rate (odds ratio, 0.72), shorter time to seizure control (mean difference, 3.41 minutes), and no difference in complications (including respiratory depression). Notably, when the time needed to place the IV line was factored into the analysis, IV benzodiazepine administration controlled seizures more quickly than administration by non-IV routes.

CITATION(S):

Alshehri A et al. Intravenous versus non-intravenous benzodiazepines for the abortion of seizures: A systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med 2017 Mar 25; [e-pub].

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