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Phenytoin or paraldehyde as the second drug for convulsions in children
  1. Will Townend,
  2. Kevin Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. kevin.mackway-jones{at}


A short cut review was carried out to establish whether phenytoin or paraldehyde should be given as the second drug for resistant fits in children. Altogether 41 papers were found using the reported search, of which none answered the question posed. Further research is needed in this area.

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Report by Will Townend, Specialist Registrar
 Checked by Kevin Mackway-Jones, Professor

Clinical scenario

A fitting three year old child presents to the emergency department. The child has received an appropriate dose of rectal diazepam from the prehospital team. After administration of a dose of intravenous lorazepam the child continues to fit. You wonder whether there is any evidence to suggest whether paraldehyde or phenytoin should be given next.

Three part question

In a [child continuing to fit after two doses of benzodiazepines] is [phenytoin or paraldehyde] more effective in [controlling seizure activity]?

Search strategy

Medline 1966–10/01 using the OVID interface. ({exp seizures OR seizure$.mp OR fit$.mp OR exp convulsions OR epilep$.mp OR exp epilepsy} AND {exp paraldehyde OR} AND { OR OR exp phenytoin}) LIMIT to human AND English.

Search outcome

Altogether 41 papers found of which none were relevant to the original question.


There is no research in this area.


Consensus guidelines should be followed.

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