Anticonvulsants for protracted seizures in children.

摘要

Shafique Ahmad and colleagues (May 13, p 1591)1 compare intranasal lorazepam with intramuscular par-aldehyde for childhood protracted seizure and suggest that intranasal lorazepam is better. However, some" aspects are unclear.First, Ahmad and colleagues' table 1 shows that median seizure duration before treatment is around h. Even if the seizure is not caused by hypoxia and median oxygen saturation at enrolment is 98-99%, such a prolonged seizure must induce hypoxic brain injury. For this reason, the patient's condition.before arrival should be mentioned in more detail.Second, this study simultaneously compared two different variables: drug type and delivery route. Some studies have suggested that intranasal drug delivery results in higher drug uptake into the brain than intravenous injection.But paraldehyde injection is no longer given in developed countries. Although we agree that intranasal drug delivery is easier, cheaper, and faster, it is difficult for us to estimate whether the result of this study is due to the anticonvulsant, delivery route, or both.Increasing evidence has revealedthe effectiveness and lower complication rate of intranasal midazoram. Therefore, a comparison between intranasal benzodiazepines with high affinity for gamma-aminobutyric acid receptors-eg, midazoram and lorazepam-should be done to investigate the control of prolonged convulsion outside the hospital.We declare that we have no conflict of interest.