***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 OBJECTIVE The aim of this study was to evaluate the efficacy and safety of intramuscular midazolam in controlling  convulsive status epilepticus in children , by comparing it with rectal diazepam . METHODS In this r and omized trial , 100 children ( 50 in each group ) with convulsive status epilepticus aged 1 month to 16 years were enrolled and r and omly assigned into two groups to receive either 0.3 mg/kg intramuscular midazolam or 0.5 mg/kg rectal diazepam . Main outcome measure was stopping of all motor activity after drug administration . Another measures were times between patient 's arrival to emergency department till drug administration , between drug administration to seizure cessation , and between patient 's arrival to seizure cessation . RESULTS Both medication were effective for seizure control and no significant difference was found between successful treatments after administering the medication ( P = 0.061 ) . In the midazolam group , in 96 % ( 48/50 ) of cases treatment was successful and in the diazepam group , in 94 % ( 47/50 ) of cases treatment was successful . Time from arrival to administering the medication was significantly shorter in midazolam group ( P = 0.017 ) . The majority of seizures in midazolam group were stopped in less than 66 s ( median ) compared to 130 s ( median ) for diazepam group , ( P < 0.001 ) . No serious adverse effects were seen in both groups . CONCLUSION IM midazolam is not superior but may be at least as effective as rectal diazepam for controlling of status epilepticus in children .  Midazolam via IM route could be one of the choices in children with convulsive status seizures who have difficult IV access 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 Summary Background Episodes of childhood convulsive status epilepticus ( CSE ) commonly start in the community . Treatment of CSE aims to minimise the length of seizures , treat the causes , and reduce adverse outcomes ; however , there is a paucity of data on the treatment of childhood CSE . We report the findings from a systematic , population -based study on the treatment of community-onset childhood CSE . Methods We collected data prospect ively on children in north London , UK , who had episodes of CSE ( ascertainment 62–84 % ) . The factors associated with seizure termination after first-line and second-line therapies , episodes of CSE lasting for longer than 60 min , and respiratory depression were analysed with logistic regression . Analysis was per protocol , and adjustment was made for repeat episodes in individuals . Results 182 children of median age 3·24 years ( range 0·16–15·98 years ) were included in the North London Convulsive Status Epilepticus in Childhood Surveillance Study ( NLSTEPSS ) between May , 2002 , and April , 2004 . 61 % ( 147 ) of 240 episodes were treated prehospital , of which 32 ( 22 % ) episodes were terminated . Analysis with multivariable models showed that treatment with intravenous lorazepam ( n=107 ) in the accident and emergency department was associated with a 3·7 times ( 95 % CI 1·7–7·9 ) greater likelihood of seizure termination than was treatment with rectal diazepam ( n=80 ) . Treatment with intravenous phenytoin ( n=32 ) as a second-line therapy was associated with a 9 times ( 95 % CI 3–27 ) greater likelihood of seizure termination than was treatment with rectal paraldehyde ( n=42 ) . No treatment prehospital ( odds ratio [ OR ] 2·4 , 95 % CI 1·2–4·5 ) and more than two doses of benzodiazepines ( OR 3·6 , 1·9–6·7 ) were associated with episodes that lasted for more than 60 min . Treatment with more than two doses of benzodiazepines was associated with respiratory depression ( OR 2·9 , 1·4–6·1 ) . Children with intermittent CSE arrived at the accident and emergency department later after seizure onset than children with continuous CSE did ( median 45 min [ range 11–514 min ] vs 30 min [ 5–90 min ] ; p<0·0001 , Mann-Whitney U test ) ; for each minute delay from onset of CSE to arrival at the accident and emergency department there was a 5 % cumulative increase in the risk of the episode lasting more than 60 min . Interpretation These data add to the debate on optimum emergency treatment of childhood CSE and suggest that the current guidelines could be up date d. Funding An anonymous donor to UCL Institute of Child Health ; the Wellcome Trust ; UK Department of Health National Institute for Health Research Biomedical Research Centres Funding Scheme ; Medical Research Council 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 ) There is little evidence on which to judge the optimal treatment for  convulsive status epilepticus ( CSE ) in children . This study compares the effect of intravenous ( iv ) lorazepam with iv diazepam as the first line of treatment of CSE . We studied all children with prolonged seizures arriving in the Accident and Emergency ( A&E ) Department in two separate periods . In the first 6-month period iv diazepam was used as st and ard treatment , in the second 1-year period iv lorazepam was used . We measured latency to stopping of seizure and any adverse events . A successful treatment was defined as one in which the seizure clinical ly ceased within 15 minutes after siting the iv cannula , requiring no further treatment . Intravenous diazepam ( 0.32 mg kg ( -1 ) ) was used in 17 of 26 patients , whilst iv lorazepam ( 0.13 mg kg ( -1 ) ) was used in 31 of 59 . There were no differences between the two groups regarding age , sex and seizure type . The seizure was successfully controlled 15 minutes after siting the iv cannula in 11 ( 65 % ) patients treated with diazepam ( median time of 3 minutes ) and in 20 ( 65 % ) patients treated with lorazepam ( median time of 5 minutes ) . These preliminary results suggest that iv lorazepam may be as effective as iv diazepam PURPOSE Intravenous lorazepam is considered the drug of first choice for control of acute convulsive seizures . However , re source or personnel constraints necessitate the study of alternative routes and medications . This study compared the efficacy and adverse effects of intranasal versus intravenous lorazepam in children aged 6 - 14 
    Output:
    
We have not identified any new high- quality evidence on the efficacy or safety of an anticonvulsant in stopping an acute tonic-clonic convulsion that would inform clinical practice .
There appears to be a very low risk of adverse events , specifically respiratory depression .
Intravenous lorazepam and diazepam appear to be associated with similar rates of seizure cessation and respiratory depression .
Although intravenous lorazepam and intravenous diazepam lead to more rapid seizure cessation , the time taken to obtain intravenous access may undermine this effect .
In the absence of intravenous access , buccal midazolam or rectal diazepam are therefore acceptable first-line anticonvulsants for the treatment of an acute tonic-clonic convulsion that has lasted at least five minutes .
There is no evidence provided by this review to support the use of intranasal midazolam or lorazepam as alternatives to buccal midazolam or rectal diazepam