Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus
Sunit Singhi1, Aruna Murthy, Pratibha Singhi
1Department of Pediatrics, Advance Pediatric Centre, Post-Graduate Institute of Medical Education and Research, Chandigarh, India. drsinghi@glide.net.in
Journal of Child Neurology
|April 16, 2002
Summary
Continuous midazolam and diazepam infusions effectively controlled refractory status epilepticus in children. However, midazolam showed higher seizure recurrence and mortality rates, particularly in cases of central nervous system infections.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Refractory status epilepticus (RSE) is a neurological emergency requiring prompt and effective treatment.
- Benzodiazepines, such as midazolam and diazepam, are first-line agents, but continuous infusions are often necessary for RSE.
Purpose of the Study:
- To compare the efficacy and safety of continuous midazolam versus diazepam infusion for controlling RSE in children.
- To evaluate seizure control rates, time to control, seizure recurrence, hypotension, and need for ventilation.
Main Methods:
- An open-label, randomized controlled study involving 40 children (2-12 years) with RSE.
- Patients received either continuous midazolam (n=21) or diazepam (n=19) infusion.
- RSE was defined as seizures uncontrolled after two doses of diazepam and phenytoin infusion.
Main Results:
- Both midazolam and diazepam infusions achieved high seizure control rates (86% vs. 89%, P=NS).
- Seizure recurrence was significantly higher with midazolam (57% vs. 16%, P < .05).
- Midazolam was associated with higher mortality (38% vs. 10.5%, P < .1 > .05) and similar rates of hypotension and ventilation needs.
Conclusions:
- Continuous midazolam and diazepam infusions are equally effective in controlling RSE.
- Midazolam infusion is linked to increased seizure recurrence and mortality, especially in RSE caused by CNS infections.
- Diazepam may be a safer alternative for RSE management in pediatric populations, particularly those with CNS infections.
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