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Intramuscular midazolam vs intravenous diazepam for acute seizures

Ira Shah1, C T Deshmukh

  • 1Department of Pediatrics, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai, India. irashah86@hotmail.com.

Indian Journal of Pediatrics
|September 1, 2005
PubMed

Insights

Intramuscular midazolam effectively controls acute seizures in children, acting faster than intravenous diazepam, especially for febrile convulsions. This method offers a safer alternative with fewer side effects, particularly for patients with difficult intravenous access.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pharmacology

Background:

  • Acute seizures in children pose a significant clinical challenge.
  • Intravenous diazepam is a common treatment but requires established intravenous access.
  • Alternative routes of administration are needed for efficient seizure control.

Purpose of the Study:

  • To compare the effectiveness of intramuscular midazolam versus intravenous diazepam for controlling acute seizures in children.
  • To evaluate the onset of action and side effect profiles of both treatment modalities.

Main Methods:

  • A randomized study involving 115 children (1 month to 12 years) with acute convulsions.
  • Patients without IV access received either intramuscular midazolam or intravenous diazepam.
  • Time to seizure cessation and adverse events were recorded and compared.

Main Results:

  • Intramuscular midazolam demonstrated a significantly faster onset of action (97.22 seconds) compared to intravenous diazepam (250.35 seconds in patients without prior IV access).
  • Midazolam was effective across various age groups, seizure types, and etiologies, particularly in febrile convulsions.
  • No side effects were observed with intramuscular midazolam, whereas 10.8% of patients receiving intravenous diazepam experienced thrombophlebitis.

Conclusions:

  • Intramuscular midazolam is a highly effective first-line agent for managing acute seizures in children, offering rapid seizure control.
  • It presents a safer alternative to intravenous diazepam, with a notable absence of side effects and is particularly advantageous for children lacking immediate intravenous access.
Abstract

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