[Prolonged convulsions treated with buccal midazolam in a setting of mentally retarded patients with refractory...

Convulsive status epilepticus is a common major complication of epilepsy that results in high morbidity and mortality. Early treatment of prolonged seizures with rectal diazepam has been the method of choice in order to avoid this complication. However, several randomized trials in recent years suggest that buccal midazolam is as effective and safe as rectal diazepam. This study aims to seek further confirmation of the efficacy and safety of buccal midazolam in daily clinical practice.

Ten out of 73 adult epileptic patients who were residents in a center for people with severe encephalopathy were included. We recorded all seizures over a one-year period. Prolonged seizures, defined as a seizure lasting one minute or longer, were treated by placing buccal midazolam 5 mg (1 ml) between the lower lip and the gum. We administered a second dose of midazolam when the seizure lasted more than two minutes and a third dose of midazolam, or a combination of rectal diazepam 5 mg together with midazolam, as a rescue therapy when the seizure lasted for more than 3 minutes. Vital constants were monitored.

We treated 52 prolonged seizures in 10 patients enrolled in the study. The treatment was effective with a single dose within two minutes in 80.7% of seizures. No cardiorespiratory complications were detected and no patients presented a convulsive status epilepticus.

Buccal midazolam is effective and safe in the treatment of prolonged seizures and has the advantage of being a convenient and socially acceptable administration form.