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Eight-year study of childhood status epilepticus: midazolam infusion in management and outcome
Roshan Koul1, Alexander Chacko, Hashim Javed
1Department of Child Health, Sultan Qaboos University Hospital, Sultanate of Oman. rkoul@omantel.net.om
Insights
Continuous midazolam infusion effectively controlled status epilepticus in children, even in refractory cases. This treatment showed a high success rate with minimal adverse effects, leading to complete recovery for most patients.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Status epilepticus (SE) in children is a medical emergency requiring prompt and effective treatment.
- Refractory status epilepticus (RSE) poses significant management challenges, often necessitating advanced interventions.
- Established treatment protocols for SE may not always be sufficient, particularly in RSE cases.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous midazolam infusion for treating status epilepticus in pediatric patients.
- To compare the outcomes of midazolam infusion in established versus refractory status epilepticus.
- To assess the role of midazolam as an adjunctive or primary therapy in pediatric SE.
Main Methods:
- A retrospective analysis of 68 children (2 months to 14 years) admitted with status epilepticus between November 1993 and December 2001.
- Patients included those with established SE (n=30) and refractory SE (n=38).
- Treatment protocols involved initial diazepam and/or phenytoin/phenobarbital, followed by continuous midazolam infusion (0.15 mg/kg/min bolus, then 1-7 microg/kg/min infusion) for RSE or as primary therapy.
Main Results:
- Continuous midazolam infusion was administered to 51 children.
- Midazolam was effective in controlling SE in 38 children with RSE (when added to other antiepilepsy drugs) and 13 children with established SE (as sole therapy).
- Phenytoin sodium alone controlled SE in 17 children. One child with neurodegenerative disease had uncontrolled SE. Two children required mechanical ventilation due to apnea post-diazepam/phenobarbital. No vital function compromise or metabolic derangements were noted with midazolam infusion.
Conclusions:
- Continuous midazolam infusion is a safe and effective therapeutic option for pediatric status epilepticus, including refractory cases.
- Midazolam can be used as an adjunctive therapy or as a primary agent in established SE, offering a favorable safety profile.
- The study highlights the successful management of pediatric SE with midazolam, with all survivors making a complete recovery.
Abstract:
Sixty-eight children 2 months to 14 years of age were admitted with status epilepticus to Sultan Qaboos University Hospital from November 1993 to December 2001. Thirty-eight children (55.9%) had refractory status epilepticus and 30 (44.1%) had established status epilepticus. The children with refractory status epilepticus had received intravenous or per rectal diazepam and intravenous phenytoin/phenobarbital (either or both) before continuous infusion of midazolam was given. Fifty-one children received continuous midazolam infusion. In 38 children with refractory status epilepticus, the midazolam infusion was given in addition to the long-acting antiepilepsy drug, whereas 13 (18.8%) children needed only midazolam to control the established status epilepticus. Seventeen (25%) children were controlled with phenytoin sodium alone. Midazolam was given 0.15 mg/kg/minute initially as bolus in 1 minute, followed by 1 to 7 microg/kg/minute as continuous infusion. The status could not be controlled in one child (1.5%) suffering from neurodegenerative disease. Two children needed mechanical ventilation following prolonged apnea after diazepam administration in one and diazepam plus phenobarbital in the other. No metabolic derangements or compromise of vital functions was noted on midazolam infusion. All children made a complete recovery. There was one death related to meningoencephalitis.
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