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Updated: Jun 19, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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Intranasal Versus Buccal Versus Intramuscular Midazolam for the Home and Emergency Treatment of Acute Seizures in

Maha Z Mohammed1, Iman Elagouza1, Maha El Gaafary2

  • 1Faculty of Medicine, Department of Pediatrics, Ain Shams University, Cairo, Egypt.

Pediatric Neurology
|July 24, 2024
PubMed

Insights

Midazolam is effective for treating acute seizures in children across buccal, intranasal, and intramuscular routes. No significant differences in efficacy were found, though intranasal administration offered the highest caregiver satisfaction.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Neurology

Background:

  • Benzodiazepines are first-line treatments for acute seizures.
  • Midazolam is a key benzodiazepine used in seizure management.
  • Comparing administration routes is crucial for optimizing pediatric care.

Purpose of the Study:

  • To compare the efficacy, side effects, and satisfaction of midazolam administered via buccal, intranasal, or intramuscular routes.
  • To evaluate midazolam's effectiveness in treating acute seizures in children in both home and emergency room settings.
  • To determine the optimal route for midazolam administration in pediatric seizure emergencies.

Main Methods:

  • Prospective, randomized, controlled trial involving children aged one month to 17 years.
  • Primary endpoint: seizure cessation within 10 minutes and no recurrence within 30 minutes.
  • Data collected on efficacy, side effects, and caregiver satisfaction across different administration routes.

Main Results:

  • High efficacy rates for all midazolam routes: intramuscular (94.2% home, 85.3% ER), intranasal (93.3% home, 88.2% ER), and buccal (91% home, 78.4% ER).
  • No statistically significant differences in efficacy were observed between the buccal, intranasal, and intramuscular routes in either setting (P=0.763 home, P=0.509 ER).
  • No significant cardiorespiratory events were reported across any treatment groups.

Conclusions:

  • Intramuscular, intranasal, and buccal midazolam effectively resolve most acute seizures in prehospital and emergency settings.
  • There is no statistically significant difference in efficacy among the different routes of midazolam administration.
  • The intranasal route demonstrated the highest satisfaction rate among caregivers, suggesting a preference for this method.
Abstract

Keywords:
BuccalIntramuscularIntranasalMidazolamPediatricSeizureStatus epilepticus

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