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Controlling seizures in the prehospital setting: diazepam or midazolam?
J Rainbow1, G J Browne, L T Lam
1Department of Emergency Medicine, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
Insights
Midazolam and diazepam are effective for controlling childhood seizures outside the hospital. Midazolam may be safer, causing less respiratory depression and faster treatment initiation.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Neurology
Background:
- Seizures in children require prompt prehospital treatment.
- Diazepam and midazolam are commonly used anticonvulsants.
- Comparative effectiveness and safety data in the out-of-hospital setting are crucial.
Purpose of the Study:
- To compare the efficacy and safety of prehospital diazepam versus midazolam for pediatric seizure control.
- To evaluate secondary outcomes including time to treatment and cardiorespiratory compromise.
Main Methods:
- Retrospective review of medical records for children treated by paramedics for seizures.
- Analysis of data from April 1996 to March 2000 at The Children's Hospital at Westmead.
- Comparison of seizure cessation rates, time to treatment, and cardiorespiratory events between diazepam and midazolam groups.
Main Results:
- 107 children were included; 62 received diazepam, 45 received midazolam.
- Seizure cessation within 5 minutes was observed in 37.1% of diazepam patients and 51.1% of midazolam patients.
- Apnea occurred less frequently in the midazolam group (20.0%) compared to the diazepam group (29.0%).
Conclusions:
- Midazolam demonstrates comparable seizure control efficacy to diazepam in the prehospital setting.
- Midazolam may offer advantages by potentially reducing respiratory depression and treatment initiation time.
Objective:
To determine which is the most effective and safe treatment for controlling seizures in children out-of-hospital: diazepam or midazolam.
Methods:
A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW-ED) with seizures requiring treatment in the field by paramedics was carried out over a 4-year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise.
Results:
Over the 4-year period, 2566 children presented to CHW-ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05).
Conclusion:
Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.