The options for the treatment of prolonged convulsions when intravenous access is not available include intramuscular paraldehyde and benzodiazepines by various routes: rectal diazepam, buccal midazolam, or intranasal lorazepam. Intramuscular paraldehyde has been compared with intranasal lorazepam in Malawi (

; see also Comment, ibid: 1555–6).

Over a 12-month period in 2004–05 160 consecutive children aged 2 months to 12 years (mean 19 months) presenting to the emergency department with acute seizures lasting for more than 5 min were randomised to intranasal lorazepam …