Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions

Rowland, A; Gill, AM; Stewart, AB; Appleton, RE; Al Kharusi, A; Cramp, C; Yeung, L-K

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
1 year. Data were not included on patients treated with
rectal paraldehyde for other seizure types or nonconvulsive
status epilepticus.
Results: Data analysis was undertaken regarding 53
episodes in 30 patients. Patient’s ages ranged from
5 months to 16 years (mean 6.12 years, median
5.91 years). A pre-existing diagnosis of epilepsy was
recorded in 35 episodes (66%). The mean dose of
paraldehyde was 0.65 ml/kg (SD 0.22, 95% CI 0.59 to
0.71) and median dose 0.79 ml/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
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.

• Journal Article Type: Article
• Acceptance Date: Mar 26, 2009
• Online Publication Date: Aug 21, 2009
• Publication Date: Sep 1, 2009
• Deposit Date: Apr 11, 2017
• Journal: Archives of Disease in Childhood
• Print ISSN: 0003-9888
• Electronic ISSN: 1468-2044
• Publisher: BMJ Publishing Group
• Volume: 94
• Issue: 9
• Pages: 720-723
• DOI: https://doi.org/10.1136/adc.2009.157636
• Publisher URL: https://doi.org/10.1136/adc.2009.157636
• Related Public URLs: http://adc.bmj.com/