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Midazolam in the treatment of status epilepticus in children
R Rivera1, M Segnini, A Baltodano
1Intensive Care Unit, National Children's Hospital, San José, Costa Rica.
Insights
Midazolam effectively controlled refractory status epilepticus in children when other treatments failed. This continuous infusion method proved safe and efficient for pediatric seizure management.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Pharmacology
Background:
- Status epilepticus in children is a medical emergency.
- Refractory seizures require effective and safe treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous midazolam infusion for pediatric status epilepticus.
- To assess midazolam's effectiveness in cases resistant to standard therapies.
Main Methods:
- Prospective, open-label study in a pediatric intensive care unit.
- 24 children with refractory status epilepticus received midazolam infusion after failure of diazepam, phenobarbital, and phenytoin.
- Midazolam bolus followed by a titratable infusion, monitoring seizure control, infusion rates, and side effects.
Main Results:
- Seizures were controlled in all patients within a mean of 0.78 hours.
- The mean midazolam infusion rate was 2.3 micrograms/kg/min.
- No clinically significant adverse effects on vital signs or respiratory status were observed; mean recovery to full consciousness was 4.2 hours.
Conclusions:
- Continuous midazolam infusion is an effective and safe treatment for refractory status epilepticus in children.
- Midazolam offers a viable therapeutic option for pediatric patients with difficult-to-treat seizures.
Objective:
To determine the efficacy and safety of midazolam given as a continuous infusion in the treatment of status epilepticus in children.
Design:
Prospective, open study.
Setting:
Pediatric intensive care unit.
Patients:
Twenty-four children with seizures, in whom three repeated intravenous doses of 0.3 mg/kg of diazepam, 20 mg/kg of phenobarbital, and 20 mg/kg of phenytoin failed to bring the episode under control.
Interventions:
All patients received a bolus of midazolam (0.15 mg/kg iv) followed by a continuous infusion at 1 microgram/kg/min. The dose was increased every 15 mins until the episode of seizure was brought under control. Time to control seizures, infusion rate, and side-effects were monitored.
Measurements And Main Results:
The mean age of the patient population was 2.2 yrs (range 2 months to 12 yrs; 14 female and 10 male). In all patients, seizures were controlled in a mean time of 0.78 hrs (range 15 mins to 4.5 hrs). The mean infusion rate was 2.3 micrograms/kg/min (range 1 to 18). None of the patients had clinically important changes in blood pressure, heart rate, oxygen saturation, or respiratory status attributable to the use of midazolam. The mean time to full consciousness for patients after stopping the infusion was 4.2 hrs (range 2 to 8.5).
Conclusion:
Midazolam is an effective and safe drug to control refractory seizures in children with status epilepticus.