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Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study

Tunç Fişgin1, Yavuz Gurer, Tahsin Teziç

  • 1Pediatric Neurology Department, Dr Sami Ulus Child Health and Disease Centre, Telsizler-Ankara, Turkey. fisgint@turk.net

Journal of Child Neurology
|April 16, 2002
PubMed

Insights

Intranasal midazolam is more effective than rectal diazepam for treating acute childhood convulsions. This study found midazolam had a higher success rate and required fewer additional medications, with no serious side effects observed.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Pharmacology

Background:

  • Acute convulsions in children require rapid and effective treatment.
  • Rectal diazepam is a common first-line treatment, but its efficacy can be variable.
  • Intranasal administration offers a potential alternative route for emergency medications.

Purpose of the Study:

  • To compare the efficacy and safety of intranasal midazolam versus rectal diazepam for acute convulsion treatment in children.
  • To establish a practical and safe treatment protocol for pediatric seizures.

Main Methods:

  • A comparative study evaluating rectal diazepam and intranasal midazolam in pediatric patients experiencing acute convulsions.
  • Seizure termination within 10 minutes was the primary efficacy endpoint.
  • Statistical analysis was performed to determine significant differences in response rates and need for second-line medication.

Main Results:

  • Intranasal midazolam demonstrated a higher response rate (87%) compared to rectal diazepam (60%) within 10 minutes.
  • A statistically significant difference (P < .05) showed midazolam to be more effective.
  • Fewer patients required a second medication in the midazolam group, also a statistically significant finding (P < .05).

Conclusions:

  • Intranasal midazolam is a more effective anticonvulsant agent than rectal diazepam for acute childhood seizures.
  • The intranasal route is easy to administer and was associated with no serious complications.
  • Wider availability of intranasal midazolam formulations could significantly benefit emergency room physicians.

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