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Three hundred eighty-four patients had a verified diagnosis of overt generalized convulsive status epilepticus.In this group,lorazepam was successful in 64.9 percent of those assigned to receive it,phenobarbital in 58.2 percent,diazepam and phenytoin in 55.8 percent,and phenytoin in 43.6 percent(P=0.02 for the overall comparison among the four groups). Lorazepam was significantly superior to phenytoin in a pairwise comparison (P=0.002).Among the 134 patients with verified diagnosis of subtle generalized convulsive status epilepticus,no significant differences among the treatments were detected(range of success rates,7.7 to 24.2 percent). In an intention-to-treat analysis,the differences among treatment groups were not significant,either among the patients with overt status epilepticus(P=0.12)or among those with subtle status epilepticus(P=0.91). There were no differences among the treatments with respect to recurrence during the 12-hour study period,the incidence of adverse reactions,or the outcome at 30 days.As initial intravenous treatment for overt generalized convulsive status epilepticus,lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam and phenytoin,it is easier to use. |
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