Elsevier

Epilepsy & Behavior

Volume 5, Issue 2, April 2004, Pages 253-255
Epilepsy & Behavior

Brief Communication
Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children

https://doi.org/10.1016/j.yebeh.2004.01.003Get rights and content

Abstract

Midazolam, a water-soluble benzodiazepine, is usually given intravenously in status epilepticus. The aim of this study was to determine whether intranasal midazolam is as safe and effective as intravenous diazepam in the treatment of acute childhood seizures. Seventy children aged 2 months to 15 years with acute seizures (febrile or afebrile) admitted to the pediatric emergency department of a general hospital during a 14-month period were eligible for inclusion. Intranasal midazolam 0.2 mg/kg and intravenous diazepam 0.2 mg/kg were administered after intravenous lines were established. Intranasal midazolam and intravenous diazepam were equally effective. The mean time to control of seizures was 3.58 (SD 1.68) minutes in the midazolam group and 2.94 (SD 2.62) in the diazepam group, not counting the time required to insert the intravenous line. No significant side effects were observed in either group. Although intranasal midazolam was as safe and effective as diazepam, seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam. Intranasal midazolam can possibly be used not only in medical centers, but also in general practice and at home after appropriate instructions are given to families of children with recurrent seizures.

Introduction

In the acute treatment of seizures, diazepam is undoubtedly the benzodiazepine most widely used, but its tendency to accumulate with repeated doses and very short duration of action are significant. Midazolam can be given intravenously, intramuscularly, and rectally, as well as via the nasal mucosa.

Midazolam acts rapidly and is less likely than diazepam to accumulate [1]. The plasma concentration of midazolam after intranasal administration of 0.2 mg/kg is 100 ng/ml at about 6 minutes [2]. O' Regan and colleagues examined the effectiveness of intranasal midazolam on seizure discharges recorded concurrently by electroencephalography (EEG). Their findings demonstrate unequivocally that midazolam 0.2 mg/kg is absorbed rapidly through the nasal mucosa and can eliminate spike activity on the electroencephalogram [1]. In this study we compare intranasal midazolam with intravenous diazepam for the treatment of acute childhood seizures.

Section snippets

Methods

The study was conducted in the pediatric emergency department of the Medical University of Isfahan, between September 1998 and October 1999. We randomly assigned 70 patients between 2 months and 15 years of age admitted to the emergency department of Alzahra Hospital in Isfahan with acute seizures.

Randomization was performed in advance with an odd and even number table by a pediatric assistant not involved in the study, and treatment allocations were sealed in opaque envelopes. Investigators

Results

During 14 months, 70 patients were included in this study. In all patients, in both groups, seizure control was achieved within 10 minutes, and there was no significant difference in effectiveness between intranasal midazolam and intravenous diazepam (P>0.05). The mean interval between drug administration and seizure control was 3.58 (SD 1.68) minutes for midazolam and 2.94 (SD 2.62) minutes for diazepam. The time required to insert the intravenous line was not included. There was a significant

Discussion

Midazolam, a water-soluble benzodiazepine, is an effective anticonvulsant given intravenously and intramuscularly. Intranasal midazolam is a safe and effective anesthetic in children and can suppress epileptic activity [3], [4]. Midazolam can be effective in the treatment of status epilepticus [5], [6].

Absorption of drugs is modified by, among other things, the circulation to the site of absorption, the area of the absorbing surface to which the drug is exposed, and the concentration of the

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