• Célestin Kaputu Kalala Malu, Daniel Mukeba Kahamba, Timothy David Walker, Caritas Mukampunga, Eric Mafuta Musalu, Jacques Kokolomani, Richard Mukendi Kavulu Mayamba, Jo M Wilmshurst, Jean-Marie Dubru, and Jean-Paul Misson.
• Service of Child Neurology, Kinshasa University Teaching Hospital, Democratic Republic of Congo ckaputukalalamalu@yahoo.fr.
• J. Child Neurol. 2014 Jul 1; 29 (7): 895-902.

AbstractIn Sub-Saharan Africa, intrarectal diazepam is the first-line anticonvulsant mostly used in children. We aimed to assess this standard care against sublingual lorazepam, a medication potentially as effective and safe, but easier to administer. A randomized controlled trial was conducted in the pediatric emergency departments of 9 hospitals. A total of 436 children aged 5 months to 10 years with convulsions persisting for more than 5 minutes were assigned to receive intrarectal diazepam (0.5 mg/kg, n = 202) or sublingual lorazepam (0.1 mg/kg, n = 234). Sublingual lorazepam stopped seizures within 10 minutes of administration in 56% of children compared with intrarectal diazepam in 79% (P < .001). The probability of treatment failure is higher in case of sublingual lorazepam use (OR = 2.95, 95% CI = 1.91-4.55). Sublingual lorazepam is less efficacious in stopping pediatric seizures than intrarectal diazepam, and intrarectal diazepam should thus be preferred as a first-line medication in this setting.© The Author(s) 2013.

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