Pediatric emergency medicine trisk 1441 1441
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Medical Management of an Active Seizure Beyond the
Neonatal Period
Benzodiazepines are the initial drug of choice for the treatment of seizures.
Benzodiazepines work by blocking the GABA receptor, thus increasing the
seizure threshold. Lorazepam (Ativan) has a rapid onset of action (less than 5
minutes) and should be given intravenously over 2 to 4 minutes to avoid acute
respiratory decompensation. The dose is 0.1 mg/kg, with a maximal dose of 4 mg.
Its anticonvulsant effects can last for several hours. An equally effective
alternative is diazepam 0.2 mg/kg IV (maximum dose 8 mg). Intramuscular
midazolam was shown to be at least as effective as intravenous lorazepam in
terminating status epilepticus in the prehospital setting. Midazolam dosing is 0.2
mg/kg/dose (with MAX 10 mg/dose) IM or 0.1 mg/kg/dose IV (maximum 5
mg/dose). Midazolam is shorter acting than both lorazepam and diazepam. If a
first dose of benzodiazepines fails, then a second dose should be administered at 5
minutes.
