BMJ 2001;322:107 ( 13 January )

Letters

Intranasal midazolam for treating febrile seizures in children

    Buccal midazolam should be preferred to nasal midazolam
    Safety is as important as efficacy
    Buccal midazolam for childhood seizures at home preferred to rectal diazepam
    Caution is required in applying hospital based evidence to primary care population
Caution is advised in interpreting trial conclusions

The first 150 words of the full text of this article appear below.

EDITOR---The importance of the study by Lahat et al1 is acknowledged both in the editorial by Koren2 and in subsequent correspondence, which recognises the need for effective and safe treatment for acute seizures in the community. But important methodological and analytical issues need to be clarified before the conclusions can be accepted.

The logistics of randomisation are not described in detail, although, firstly, apparently parents were asked to sign a consent form for enrolment in the study after seizures were controlled. The usual ethical practice in randomised controlled trials is to seek consent to randomisation before treatment; here, the order seems to have been reversed unless the controlled seizure actually preceded the seizure for which randomised treatment was allocated. Secondly, randomisation was apparently performed in advance, although this could refer to the frequent practice of drawing up a sequence of treatment allocations before the start of the trial, . . . [Full text of this article]
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