Tonic-clonic convulsions and convulsive status epilepticus are medical emergencies. In children, initial treatment is usually given in the Accident and Emergency (A&E) department of a hospital. Initial treatment may be administered in a number of ways including into a vein (intravenously), into the nasal or oral cavities (buccally) or into the rectum (rectally). The first choice anticonvulsant should be effective, work rapidly and not be associated with any serious adverse effects.
Four trials involving 383 participants were included. A review of two trials in children found evidence to inform a choice of intravenous lorazepam over intravenous diazepam as first line treatment for children presenting to an A&E department in an acute tonic-clonic convulsion. There is evidence from one trial to suggest that buccal midazolam is more effective than rectal diazepam in the initial management of convulsive status epilepticus in childhood where intravenous access is unavailable/unobtainable.