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Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status

Durgul Ozdemir1, Pamir Gulez, Nedret Uran

  • 1Dokuz Eylul University, School of Medicine, Department of Paediatrics, Izmir, Turkey. durgulozdemir@yahoo.com

Seizure
|February 8, 2005
PubMed

Insights

Midazolam infusion effectively controlled refractory generalized convulsive status epilepticus (SE) in children, with a 96% success rate. Treatment safety was confirmed, though mortality correlated with underlying causes of SE.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Status epilepticus (SE) is a neurological emergency often requiring continuous sedation.
  • Midazolam infusion is a common treatment for prolonged seizures.
  • Refractory generalized convulsive SE in children presents significant management challenges.

Purpose of the Study:

  • To evaluate the efficacy and safety of continuous midazolam infusion for treating refractory generalized convulsive SE in pediatric patients.
  • To assess the impact of midazolam treatment on seizure control and patient mortality.
  • To identify factors influencing treatment outcomes in childhood SE.

Main Methods:

  • A cohort of 27 children with refractory generalized convulsive SE was studied.
  • Midazolam was administered as an initial bolus followed by a continuous infusion (1-5 microg/kg/min).
  • Clinical data, seizure response, and adverse events were systematically recorded.

Main Results:

  • Complete seizure control was achieved in 96% of patients within 65 minutes using a mean midazolam infusion rate of 3.1 microg/kg/min.
  • No significant adverse effects like hypotension or respiratory depression were observed during midazolam infusion.
  • Mortality occurred in 19% of patients, primarily those with acute symptomatic etiologies or progressive encephalopathy.

Conclusions:

  • Continuous midazolam infusion demonstrates high efficacy and a favorable safety profile for managing refractory generalized convulsive SE in children.
  • The underlying etiology of SE is a critical determinant of treatment response and patient survival.
  • Midazolam is a valuable therapeutic option for pediatric refractory SE.
Abstract

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