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Intravenous midazolam for the treatment of refractory status epilepticus
1Department of Internal Medicine, University of Manitoba Health Sciences Center, Winnipeg, Canada.
Objective:
To determine the usefulness of midazolam as a therapeutic agent for status epilepticus refractory to conventional treatment.
Design:
Retrospective study.
Setting:
ICUs of two university hospitals.
Patients:
Seven patients with refractory status epilepticus who failed treatment with diazepam, lorazepam, and phenytoin, with or without phenobarbital. All patients received mechanical ventilation before receiving midazolam.
Interventions:
Intravenous midazolam by bolus administration followed by infusion.
Measurements And Main Results:
Midazolam terminated status epilepticus in all patients in less than 100 secs, as determined by clinical observation (three patients) or electroencephalographic monitoring (four patients). One patient developed mild hypotension.
Conclusions:
In this small study, midazolam appears to be an effective and safe alternative to high-dose barbiturate coma for the termination of status epilepticus when conventional agents have failed.