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[Continuous midazolam infusion for refractory nonconvulsive status epilepticus in children]

Tatsuro Nobutoki1, Kenji Sugai, Michio Fukumizu

  • 1Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo. nobutokit@mie-m.hosp.go.jp

No to Hattatsu = Brain and Development
|September 17, 2005
PubMed

Insights

Continuous midazolam infusion effectively treated refractory nonconvulsive status epilepticus (NCSE) in children. This safe first-line therapy demonstrated efficacy in most cases without serious adverse events.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Clinical Pharmacology

Context:

  • Refractory nonconvulsive status epilepticus (NCSE) presents a significant therapeutic challenge in pediatric populations.
  • Existing treatment options for NCSE may have limited efficacy or significant side effects.
  • Continuous intravenous infusion of midazolam (MDL) is an option for managing refractory NCSE.

Purpose:

  • To evaluate the efficacy and safety of continuous midazolam infusion as a first-line therapy for pediatric refractory nonconvulsive status epilepticus (NCSE).

Summary:

  • Seven episodes of refractory NCSE in five children were treated with continuous midazolam infusion.
  • An initial bolus followed by a slow-titrated infusion (0.1-0.4 mg/kg/hr) was administered.
  • Electroencephalogram (EEG) and vital signs were monitored throughout treatment.
  • NCSE was abolished within hours in five of seven episodes.
  • Two patients maintained normal functions during infusion.
  • One patient experienced recurrence unresponsive to maximum dose.
  • No serious complications like respiratory depression or hypotension were observed.

Impact:

  • Continuous midazolam infusion demonstrates significant efficacy in controlling pediatric refractory NCSE.
  • The treatment is well-tolerated, with a favorable safety profile, lacking serious adverse events.
  • This approach offers a safe and effective first-line therapeutic option for pediatric NCSE, potentially improving patient outcomes.

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