High-dose midazolam infusion for refractory status epilepticus

Area of Science:

• Neurology
• Critical Care Medicine

Background:

• Refractory status epilepticus (RSE) is a life-threatening neurological emergency.
• Current treatment protocols for RSE often involve continuous intravenous midazolam (cIV-MDZ).
• Optimal dosing strategies for cIV-MDZ in RSE remain under investigation.

Purpose of the Study:

• To compare the safety and efficacy of high-dose versus low-dose cIV-MDZ protocols in adults with RSE.
• To evaluate seizure control, hospital course, and patient outcomes between the two treatment groups.

Main Methods:

• Retrospective comparison of adult patients with RSE treated with high-dose cIV-MDZ (n=100) versus low-dose cIV-MDZ (n=29).
• Data collected included baseline characteristics, cIV-MDZ doses, seizure control, duration of infusion, time to treatment initiation, and outcomes.
• Statistical analysis was performed to compare outcomes between the high-dose and low-dose groups.

Main Results:

• The high-dose group received significantly higher median maximum cIV-MDZ doses (0.4 mg/kg/h vs 0.2 mg/kg/h) and initiated treatment sooner.
• Withdrawal seizures were less frequent in the high-dose group (15% vs 64%).
• Discharge mortality was lower in the high-dose group (40% vs 62% in multivariate analysis), despite similar rates of ultimate cIV-MDZ failure and hospital complications.

Conclusions:

• High-dose cIV-MDZ is a safe and effective treatment for RSE.
• Higher cIV-MDZ doses are associated with reduced seizure recurrence after discontinuation and potentially lower mortality.
• These findings support the use of higher infusion rates for cIV-MDZ in managing RSE.