Midazolam in the treatment of status epilepticus in children

Abstract

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.