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[Use of intravenous midazolam in status epilepticus in children]
J Lemerle1, P Daoud, M L Moutard
1Unité de réanimation pédiatrique, hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
High doses of midazolam (MDZ) effectively treated status epilepticus in children. While generally safe, optimal dosing and duration require further study for this refractory condition.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Status epilepticus (SE) management typically involves benzodiazepines, phenytoin, and phenobarbital.
- Midazolam (MDZ), a short-acting benzodiazepine, presents a potential alternative for SE treatment.
Observation:
- Four pediatric patients (3 days to 4 years) with life-threatening illnesses developed status epilepticus.
- Intravenous (IV) midazolam (MDZ) bolus (300-500 mcg/kg) followed by continuous infusion (100-300 mcg/kg/h) was administered.
Findings:
- Seizures ceased within 1 hour post-MDZ bolus in all patients.
- No acute adverse events were observed; one patient experienced manageable withdrawal symptoms.
- Neurologic sequelae were attributed to the underlying severe illness, not MDZ treatment.
Implications:
- High-dose midazolam (MDZ) demonstrates efficacy in refractory status epilepticus.
- Further research is needed to establish optimal dosage and treatment duration for MDZ in pediatric SE.
- MDZ offers a viable option for managing severe, refractory seizures in critically ill children.
Background:
Status epilepticus is usually treated by benzodiazepines such as diazepam or clonazepam in association with phenytoin and phenobarbital. Midazolam (MDZ) is a recently developed short-elimination half-life benzodiazepine.
Case Reports:
Four children, aged 3 days to 4 years, were hospitalized in the pediatric intensive care unit for life-threatening illness and developed status epilepticus. They were given an i.v. bolus dose of 300 to 500 micrograms/kg of MDZ immediately followed by a continuous i.v. infusion at the dose of 100 to 300 micrograms/kg/h. All seizures stopped within 1 hour after the bolus dose administration. No acute adverse events of MDZ were noted. Withdrawal symptoms in one patient were controlled by progressive reduction of MDZ doses. Neurologic sequelae were noted in three children, secondary to their primitive illness.
Conclusions:
High doses of MDZ are effective for treating refractory status epilepticus; optimal dosage and duration of treatment remains to be determined.
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