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Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions
  1. Andrew Graeme Rowland (andrew.rowland{at}doctors.net.uk)
  1. Alder Hey Children's NHS Foundation Trust, United Kingdom
    1. Andrea M Gill (andrea.gill{at}alderhey.nhs.uk)
    1. Alder Hey Children's NHS Foundation Trust, United Kingdom
      1. Anne Briar Stewart (briar.stewart{at}alderhey.nhs.uk)
      1. Alder Hey Children's NHS Foundation Trust, United Kingdom
        1. Richard E Appleton (richard.appleton{at}alderhey.nhs.uk)
        1. Alder Hey Children's NHS Foundation Trust, United Kingdom
          1. Asya M Al-Kharusi
          1. Southport & Ormskirk NHS Trust, United Kingdom
            1. Celia Cramp
            1. Royal Shrewsbury Hospital, United Kingdom
              1. Lap-Kong Yeung
              1. Fairfield General Hospital, United Kingdom

                Abstract

                Introduction: The aim of this prospective audit was to assess the effectiveness and safety of rectal paraldehyde in the management of acute, including prolonged, tonic-clonic convulsions. There are very limited published data on its effectiveness and safety and previous data have focused on its intramuscular route of administration.

                Methods: Four hospitals participated in the study. Information was collected on each dose of paraldehyde used for the treatment of a tonic-clonic convulsion over one year. Data were not included on patients treated with rectal paraldehyde for other seizure types or non-convulsive status epilepticus.

                Results: Data analysis was undertaken in 53 episodes in 30 patients. Patient’s ages ranged from 5 months to 16 years (mean 6.12 years and median 5.91 years). A pre-existing diagnosis of epilepsy was recorded in 35 episodes (66%).

                The mean dose of paraldehyde was 0.65ml/kg (standard deviation 0.22 ml/kg, 95% confidence interval +/- 0.06ml/kg) and median dose 0.79ml/kg.

                Rectal paraldehyde terminated the convulsion in 33 (62.3%) of the 53 episodes. In the 35 episodes where a pre-existing diagnosis of epilepsy was recorded, paraldehyde stopped the convulsion on 26 (74.3%) occasions. There was no difference in the dose of paraldehyde between the episodes where the convulsion was or was not terminated.

                There was no recorded respiratory depression in any episode.

                Conclusions: This study provides unique evidence that supports the belief that rectal paraldehyde is effective and safe in treating acute prolonged tonic-clonic convulsions. This would appear to confirm that paraldehyde should remain a treatment for the management of prolonged tonic-clonic convulsions, including convulsive status epilepticus.

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