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Midazolam coma for refractory status epilepticus in children.
J Igartua1, P Silver, J Maytal
1Division of Critical Care Medicine, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Critical Care Medicine
|October 3, 1999
Summary
This study shows that a midazolam coma algorithm effectively treats refractory status epilepticus. The treatment is safe, with no cardiovascular instability observed, and often stops seizures before burst suppression is achieved on EEG.
Area of Science:
- Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Refractory status epilepticus (RSE) is a life-threatening neurological emergency.
- Current treatment options for RSE can be limited and associated with significant side effects.
- Midazolam coma is a recognized treatment for RSE, but a standardized algorithm is needed.
Purpose of the Study:
- To implement and retrospectively evaluate a therapeutic algorithm for treating refractory status epilepticus using a midazolam-induced coma.
- To assess the efficacy and safety of this algorithm in a cohort of patients with RSE.
Main Methods:
- Eight consecutive patients with RSE were mechanically ventilated and continuously monitored via invasive arterial/central venous pressure and 16-channel video electroencephalogram (EEG).
- A standardized algorithm involving midazolam bolus and titration of continuous infusion was applied.
- Seizure cessation and/or EEG burst suppression determined the treatment endpoint and subsequent weaning protocol.
Main Results:
- The algorithm successfully terminated seizures in seven out of eight patients.
- Maximal midazolam doses ranged from 4-24 microg/kg/min (mean 14 +/- 6 microg/kg/min).
- Patients maintained stable cardiovascular function without requiring inotropic support, even at doses achieving burst suppression.
Conclusions:
- The described midazolam infusion algorithm is effective for terminating refractory status epilepticus.
- This therapeutic approach is not associated with cardiovascular instability.
- Seizure cessation is frequently achieved prior to reaching EEG burst suppression.