***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Convulsive status epilepticus is the most common neurological medical emergency and has high morbidity and mortality . Early treatment before admission to hospital is best with an effective medication that can be administered safely . We aim ed to find out whether there are differences in efficacy and adverse events between buccal administration of liquid midazolam and rectal administration of liquid diazepam in the acute treatment of seizures . METHODS At a residential school with on-site medical facilities 42 young people with severe epilepsy were enrolled . Continuous seizures of more than 5 min duration were r and omly treated with buccal midazolam or rectal diazepam . If the seizure did not stop within 10 min additional medication chosen by the attending physician was administered . We monitored oxygen saturation and blood pressure for 30 min after treatment . The main outcome measures were efficacy , time from arrival of the nurse to drug administration , time from drug administration to end of seizure , and incidence of adverse cardiorespiratory events . FINDINGS Buccal midazolam was used to treat 40 seizures in 14 students , and rectal diazepam 39 seizures in 14 students . Midazolam stopped 30 ( 75 % ) of 40 seizures and diazepam 23 ( 59 % ) of 39 ( p=0.16 ) . The median time from arrival of the nurse to administration of medication was 2 min . Time from administration to end of seizure did not differ significantly between the two treatments . No clinical ly important adverse cardiorespiratory events were identified in the two groups . Buccal midazolam was universally acceptable to the nursing and care staff . INTERPRETATION Buccal midazolam is at least as effective as rectal diazepam in the acute treatment of seizures . Administration via the mouth is more socially acceptable and convenient and may become the preferred treatment for long seizures that occur outside hospital Lorazepam was compared with diazepam for the treatment of  acute convulsions and status epilepticus in 102 children in a prospect i ve , open , ' odd and even date s ' trial .  Convulsions were controlled in 76 per cent of patients treated with a single dose of lorazepam and 51 per cent of patients treated with a single dose of diazepam . Significantly fewer patients treated with lorazepam required additional anticonvulsants to terminate the seizure . Respiratory depression occurred in 3 per cent of lorazepam-treated patients and 15 per cent of diazepam-treated patients . No patient who received lorazepam required admission to the intensive care unit for either respiratory depression or persisting status epilepticus . Rectally administered lorazepam appeared to be particularly valuable ( 100 per cent efficacy ) when venous access was not possible INTRODUCTION The evidence based data to guide management in patients of benzodiazepine refractory status epilepticus ( SE ) is still lacking . We conducted a r and omized study to evaluate the comparative effect of intravenous ( IV ) phenytoin and intravenous valproate ( IV VA ) in patients of benzodiazepine refractory SE . BACKGROUND AND METHODS Hundred , age and sex matched , patients of benzodiazepine refractory SE were r and omly divided into Group A ( 50 patients ) , treated with IV VA and Group B ( 50 patients ) treated with IV phenytoin .  Twelve patients , in whom SE was not controlled with a single drug , were switched over to the other group . Treatment was considered successful when all motor or EEG seizure activity ceased within 20 min after the beginning of the drug infusion and no return of seizure activity during the next 12h . Secondary study end points were adverse events to treatment , in-hospital complications and the neurological outcome at discharge . RESULTS In this study , IV VA was successful in 88 % and IV phenytoin in 84 % ( p>0.05 ) of patients of SE with a significantly better response in patients of SE < 2h ( p<0.05 ) . The total number of adverse events did not differ significantly between the two groups ( p>0.05 ) . There were no differences among the treatments with respect to recurrence after 12-h study period or the outcome at 7 days . CONCLUSION IV VA is as effective as IV phenytoin . It is easy to use , better tolerated and can be used as an alternative to IV phenytoin in patients of benzodiazepine refractory SE , especially in patients of cardio-respiratory disease . The better outcome in patients having shorter duration of SE ( < 2h ) suggests need of immediate treatment The objective of this study was to compare the efficacy of continuous midazolam and diazepam infusion for the control of refractory status epilepticus . An open-label , r and omized control study was undertaken at the Pediatric Emergency and Intensive Care Service of a multidisciplinary teaching and referral hospital . Subjects included 40 children , 2 to 12 years of age , with refractory status epilepticus ( motor seizures uncontrolled after two doses of diazepam , 0.3 mg/kg per dose , and phenytoin infusion , 20 mg/kg ) . Either continuous midazolam ( n = 21 ) or diazepam infusion ( n = 19 ) in incremental doses was administered . The primary outcome measure was the proportion of children in each group with successful control of refractory status epilepticus . The secondary outcome measure was the time to control seizure activity , recurrence of seizure after initial control , if any , the frequency of hypotension , and the need for ventilation .  The two groups were similar in age ( mean ± SD = 4.9 ± 43.6 months ) and etiology . Twenty-three ( 57.5 % ) patients had acute central nervous system infection . Refractory status epilepticus was controlled in 18 ( 86 % ) and 17 ( 89 % ) patients in the midazolam and diazepam groups , respectively ( P = not significant ) . The median time to seizure control was 16 minutes in both groups , but in the midazolam group , seizures recurred in more children ( 57 % versus 16 % in diazepam group ; P < .05 ) . The maximum dose ( mean ± SD ) of midazolam and diazepam required was 5.3 ± 2.6 μg/kg/min and 0.04 ± 0.02 mg/kg/min , respectively . About half of the patients needed mechanical ventilation and 40 % had hypotension in both groups , but the mortality was higher in the midazolam group ( 38 % ) as compared to the diazepam group ( 10.5 % , P < . 1 > .05 ) . Continuous midazolam and diazepam infusions were equally effective for control of refractory status epilepticus . However , midazolam was associated with more seizure recurrence and higher mortality in refractory status epilepticus predominantly caused by central nervous system infections . ( J Child Neurol 2002;17:106 - 110 ) BACKGROUND Early termination of prolonged seizures with intravenous administration of benzodiazepines improves outcomes . For faster and more reliable administration , paramedics increasingly use an intramuscular route . METHODS This double-blind , r and omized , noninferiority trial compared the efficacy of intramuscular midazolam with that of intravenous lorazepam for children and adults in status epilepticus treated by paramedics . Subjects whose convulsions had persisted for more than 5 minutes and who were still convulsing after paramedics arrived were given the study medication by either intramuscular autoinjector or intravenous infusion . The primary outcome was absence of seizures at the time of arrival in the emergency department without the need for rescue therapy . Secondary outcomes included endotracheal intubation , recurrent seizures , and timing of treatment relative to the cessation of convulsive seizures . This trial tested the hypothesis that intramuscular midazolam was noninferior to intravenous lorazepam by a margin of 10 percentage points . RESULTS At the time of arrival in the emergency department , seizures were absent without rescue therapy in 329 of 448 subjects ( 73.4 % ) in the intramuscular-midazolam group and in 282 of 445 ( 63.4 % ) in the intravenous-lorazepam group ( absolute difference , 10 percentage points ; 95 % confidence interval , 4.0 to 16.1 ; P<0.001 for both noninferiority and superiority ) . The two treatment groups were similar with respect to need for endotracheal intubation ( 14.1 % of subjects with intramuscular midazolam and 14.4 % with intravenous lorazepam ) and recurrence of seizures ( 11.4 % and 10.6 % , respectively ) . Among subjects whose seizures ceased before arrival in the emergency department , the median times to active treatment were 1.2 minutes in the intramuscular-midazolam group and 4.8 minutes in the intravenous-lorazepam group , with corresponding median times from active treatment to cessation of convulsions of 3.3 minutes and 1.6 minutes . Adverse-event rates were similar in the two groups . CONCLUSIONS For subjects in status epilepticus , intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizure cessation . ( Funded by the National Institute of Neurological Disorders and Stroke and others ; Clinical Trials.gov number , Clinical Trials.gov NCT00809146 . ) BACKGROUND In sub-Saharan Africa , rectal diazepam or intramuscular paraldehyde are commonly used as first-line anticonvulsant agents in the emergency treatment of seizures in children . These treatments can be expensive and sometimes toxic . We aim ed to assess a drug and delivery system that is potentially more effective , safer , and easier to administer than those presently in use . METHODS We did an open r and omised trial in a paediatric emergency department of a tertiary hospital in Malawi . 160 children aged over 2 months with seizures persisting for more than 5 min were r and omly assigned to receive either intranasal lorazepam ( 100 microg/kg , n=80 ) or intramuscular paraldehyde ( 0.2 mL/kg , n=80 ) . The primary outcome measure was whether the presenting seizure stopped with one dose of assigned anticonvulsant agent within 10 min of administration . The primary analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00116064 . FINDINGS Intranasal lorazepam stopped convulsions within 10 min in 60 ( 75 % ) episodes treated ( absolute risk 0.75 , 95 % CI 0.64 - 0.84 ) , and intramuscular paraldehyde in 49 ( 61.3 % ; absolute risk 0.61 , 95 % CI 0.49 - 0.72 ) . No clinical ly important cardiorespiratory events were seen in either group ( 95 % binomial exact CI 0 - 4.5 % ) , and all children finished the trial . INTERPRETATION Intranasal lorazepam is effective , safe , and provides a less invasive alternative to intramuscular paraldehyde in children with protracted convulsions . The ease of use of this drug makes it an attractive and preferable prehospital treatment option Objective : To compare treatment of ongoing seizures using intramuscular ( IM ) midazolam versus intravenous ( IV ) diazepam Design : Controlled clinical trial Patients : Children with motor seizures of at least 10 minutes ' duration Main outcome measures : Time to cessation of seizures Results : Twenty-four patients were enrolled ( 13 midazolam , 11 diazepam ) . Initial treatment with either midazolam or diazepam was successful in 22 of the 24 patients . One patient in each group failed therapy and eventually required endotracheal intubation and general anesthesia for convulsive status epilepticus lasting more than one hour . Patients in the midazolam group received medication sooner ( 3.3 ± 2.0 vs 7.8 ± 3.2 minutes , P=0.001 ) and had more rapid cessation of their seizures ( 7.8 ± 4.1 vs 11.2 ± 3.6 , P=0.047 ) than patients r and omized to receive diazepam Conclusions : IM midazolam is an effective anticonvulsant for children with motor seizures . Compared to IV diazepam , IM midazolam results in more rapid cessation of seizures because of more rapid administration . The IM route of administration may be particularly useful in physicians ' offices , in the prehospital setting , and for children with difficult IV A single 18 mg/kg dose of oral phenytoin capsules or suspension ( mean dose , 1.3 g ) was given to 44 patients with recent seizures and no detectable serum phenytoin level .  Mean serum phenytoin levels after loading for patients receiving capsules were 6.8 micrograms/mL at two hours , 9.7 micrograms/mL at three to five hours , 12.3 micrograms/mL at six to ten hours , and 15.1 micrograms/mL at 16 to 24 hours . Mean levels for patients receiving suspension were slightly , but not significantly 
    Output:
    
Intravenous lorazepam is better than intravenous diazepam or intravenous phenytoin alone for cessation of seizures .
Intravenous lorazepam also carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia compared with intravenous diazepam .
Both intravenous lorazepam and diazepam are better than placebo for the same outcomes .
For pre hospital management , midazolam IM seemed more effective than lorazepam IV for cessation of seizures , frequency of hospitalisation and ICU admissions however , it was unclear whether the risk of recurrence of seizures differed between treatments .
Diazepam gel was better than placebo gel in reducing the risk of non-cessation of seizures .