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Intramuscular Versus Buccal Midazolam for Pediatric Seizures: A Randomized Double-Blinded Trial

Khalid Alansari1, Magda Barkat2, AbdelNasir H Mohamed2

  • 1Department of Emergency Medicine, Sidra Medicine, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.

Pediatric Neurology
|May 11, 2020
PubMed

Insights

Intramuscular midazolam is a favorable first-line treatment for pediatric seizures compared to buccal midazolam. This study found intramuscular midazolam to be more effective and safer for active seizures in children.

Area of Science:

  • Emergency Medicine
  • Pediatric Neurology
  • Pharmacology

Background:

  • Active seizures in children require prompt and effective first-line treatment.
  • Midazolam is a commonly used medication for seizure management.
  • Comparing different administration routes is crucial for optimizing pediatric emergency care.

Purpose of the Study:

  • To compare the efficacy and safety of intramuscular versus buccal midazolam as first-line treatment for active seizures in pediatric patients.
  • To evaluate seizure cessation rates, need for additional medication, seizure duration, and adverse events.

Main Methods:

  • A double-blind, double-dummy randomized trial was conducted.
  • 150 children with active seizures lasting over five minutes were enrolled.
  • Primary outcome was seizure cessation within five minutes of drug administration; secondary outcomes included need for additional medication, seizure duration, and side effects.

Main Results:

  • Seizure cessation occurred in 61% of the intramuscular group versus 46% of the buccal group (P=0.07).
  • Fewer patients required additional anti-seizure treatment in the intramuscular group (39%) compared to the buccal group (51%).
  • One patient in the intramuscular group experienced respiratory depression and hypotension; no side effects were attributed to buccal midazolam.

Conclusions:

  • Intramuscular midazolam demonstrates favorable efficacy and safety compared to buccal midazolam for first-line treatment of pediatric seizures.
  • Intramuscular administration may be a more effective route for rapid seizure control in children.
  • Further research could explore optimal dosing and patient selection for each administration route.
Abstract

Keywords:
BuccalCessation of seizureIntramuscularLength of stayMidazolamSeizureStatus epilepticus

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