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Continuous midazolam infusion as treatment of status epilepticus
R L Koul1, G Raj Aithala, A Chacko
1Department of Child Health, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman.
Insights
Midazolam infusion effectively controlled seizures in 19 of 20 children with status epilepticus. This treatment proved safe, with no vital function compromise, offering a viable option for pediatric emergency care.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
Background:
- Status epilepticus is a medical emergency in children.
- Refractory status epilepticus often requires multiple anticonvulsant agents.
Purpose of the Study:
- To evaluate the efficacy and safety of midazolam infusion for treating status epilepticus in children.
Main Methods:
- A prospective study involving 20 children with status epilepticus.
- Midazolam was administered as a bolus (0.15 mg/kg) followed by continuous infusion (1-5 micrograms/kg/min).
- Prior treatments with diazepam and phenytoin/phenobarbitone were noted for refractory cases.
Main Results:
- Seizures were controlled in 19 out of 20 children.
- Mean time to seizure cessation was 0.9 hours.
- Full consciousness was regained within a mean of 5.1 hours post-treatment without adverse events.
Conclusions:
- Midazolam infusion is an effective and safe therapeutic option for childhood status epilepticus.
- It demonstrates rapid seizure control and a favorable safety profile.
Abstract:
In a tertiary referral centre, midazolam infusion was tried as treatment for 20 children with status epilepticus over a period of two years. The mean age of the children was 4.07 years. Twelve children with refractory status epilepticus had received intravenous or per rectal diazepam and intravenous phenytoin/ phenobarbitone or both before midazolam was given (0.15 mg/kg bolus followed by 1-5 micrograms/kg/min infusion). Eight children required only midazolam to control the established status epilepticus. The seizures were controlled in 19 children. The mean time required for complete cessation of seizures was 0.9 hours. The mean infusion rate required was 2.0 micrograms/kg/min. All children had regained full consciousness by a mean of 5.1 hours after discontinuation of midazolam treatment. No metabolic derangement or compromise of vital functions was noted in any of the children. Midazolam infusion is thus an effective and safe therapeutic approach for the management of childhood status epilepticus.