Original articleIntranasal Midazolam vs Rectal Diazepam in Acute Childhood Seizures
Introduction
Seizure, a common neurologic medical emergency, continues to be associated with significant morbidity and mortality in the pediatric age group and affects 4-7% of children [1]. Early domiciliary treatment of seizures in the community, school, or home with drugs that can be administered by parents, teachers, or nonmedical staff may be beneficial and can decrease morbidity and mortality [2]. In planning domiciliary therapy, the safety, ease of administration, choice of drug, route of therapy, and the practicability of familiarization by the user are important issues. Various drugs administered through different routes have been tried in the management of acute seizures.
Rectal diazepam has been used successfully for home and hospital treatment of acute seizures [3]. Its use may be socially embarrassing and undesirable. Moreover, some special arrangement is required to administer it, which is difficult to arrange in homes, schools, and daycare centers. An effective treatment that can be easily administered by a more convenient, socially acceptable route is therefore needed.
Midazolam, a benzodiazepine, has been described as an alternative rescue medication in the management of acute seizures [4], [5]. Recent studies have demonstrated intranasal midazolam to be effective in the management of acute childhood seizures [6], [7], [8], [9], [10]. However, not many comparative studies have been undertaken, and the search for an easily administrable, effective drug to control acute seizure continues.
In the light of the above background, the present study was undertaken to compare the efficacy and side effects of intranasal midazolam and rectal diazepam in the treatment of acute childhood seizures.
Section snippets
Materials and Methods
This study was a randomized, controlled, single masked study. All types of seizures including febrile seizures and all types of epilepsy in children of either sex, ages 3 months to 12 years, who attended the Institute’s outpatient department or emergency were included in the study. A written consent was obtained from the parents or guardians of children regarding their willingness to participate in the study. The study was approved by the Institute ethical committee.
Drugs used in this study
Results
Of 188 seizure episodes in 46 children under study, 96 episodes were treated with rectal diazepam and 92 with intranasal midazolam. The diagnoses of these 46 children and the type of seizures are summarized in Table 1 and Table 2, respectively. Comparative baseline characteristics of the two groups under study are presented in Table 3A, Table 3B.
After comparing the baseline characteristics between the two groups, which did not vary significantly, an analysis of the 188 seizure episodes (96
Discussion
Early termination of seizures is important to prevent many adverse consequences and reduce the risk of development of status epilepticus. In a hospital setup, intravenous diazepam is commonly used for control of acute seizures, but it requires prompt establishment of an intravenous line and has the disadvantage of being a respiratory depressant [12]. Rectal diazepam is another alternative route, but is not always reliable owing to its variable bioavailability and wide range of serum
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