EC Paediatrics

Research Article Volume 13 Issue 6 - 2024

Frequency of Successful Outcome of Intramuscular Midazolam for the Treatment of Status Epilepticus in Children

Aiman Islam1, Afsheen Batool Raza2*, Muhammad Khalid Masood3 and Nadia Nawaz4

1The Children’s Hospital and University of Child Health Sciences, Lahore, Pakistan
2Associate Professor of Pediatrics, The Children’s Hospital and University of Child Health Sciences, Lahore, Pakistan
3Professor of Paediatrics, University of Child Health Sciences, Lahore, Pakistan
4Senior Registrar, Children’s Hospital, Lahore, Pakistan

*Corresponding Author: Afsheen Batool Raza, Associate Professor of Pediatrics, The Children’s Hospital and University of Child Health Sciences, Lahore, Pakistan.
Received: May 06, 2024; Published: May 27, 2024



Aims and Objectives:

  1. To find out the frequency of successful outcome of intramuscular midazolam for the treatment of status epilepticus in children.
  2. To compare successful outcome with respect to previous history of convulsions.

Patients and Methods: This cross sectional study was conducted in department of Paediatrics Children’s Hospital Lahore. Non-probability consecutive sampling technique was used and a total of 370 patients meeting inclusion criteria were included in this study. After taking an informed consent, patient’s contact information and demographic data was obtained. IM midazolam was used with a dose of 0.3 mg/kg and was injected into the left quadriceps muscle and final outcome was noted.

Results: The mean age of cases was 7.68 ± 4.10 years with minimum age as 4 months and maximum 14 years. One hundred (27%) cases had past history of seizures. A total of 350 (94.6%) cases had successful outcome while in 20 (5.4%) of the cases the outcome was not successful.

Conclusion: In this study, IM midazolam is found successful for the treatment of status epilepticus in children. Thus, this mode of treatment can be utilized in treating such cases to gain maximum therapeutic effectiveness.

 Keywords: Status Epilepticus; Seizures; Benzodiazepines; Midazolam; Diazepam

  1. Saz EU., et al. “Convulsive status epilepticus in children: etiology, treatment protocol and outcome”. Seizure2 (2011): 115-118.
  2. Brophy GM., et al. “Guidelines for the evaluation and management of status epilepticus”. Neurocritical Care 1 (2012): 3-23.
  3. Lissauer S., et al. “Buccal, intranasal or intravenous lorazepam for the treatment of acute convulsions in children in Malawi: An open randomized trial: Le lorazépam par voieorale, intranasaleouintraveineuse pour le traitement des convulsions aiguës chez l’enfant au Malawi: étudeouverterandomisée”. African Journal of Emergency Medicine 3 (2015): 120-126.
  4. Loddenkemper T and Goodkin HP. “Treatment of pediatric status epilepticus”. Current Treatment Options in Neurology 6 (2011): 560-573.
  5. Glauser T., et al. “Evidence-based guideline: treatment of convulsive Status Epilepticus in Children and Adults: report of the guideline committee of the American Epilepsy society”. Epilepsy Currents 1 (2016): 48-61.
  6. Sánchez Fernández I., et al. “Pathophysiology of convulsive status epilepticus”. Seizure 68 (2019): 16-21.
  7. Momen AA., et al. “Efficacy and safety of intramuscular midazolam versus rectal diazepam in controlling status epilepticus in children”. European Journal of Paediatric Neurology 2 (2015): 149-154.
  8. Diastat C-IV diastatAcuDial™ C-IV (diazepam rectal gel) (2021).
  9. Verrotti A., et al. “Pediatric status epilepticus: improved management with new drug therapies?” Expert Opinion on Pharmacotherapy 8 (2017): 789-798.
  10. Pellock JM. “Use of midazolam for refractory status epilepticus in pediatric patients”. Journal of Child Neurology 12 (1998): 581-587.
  11. Samanta D. “Rescue therapies for seizure emergencies: current and future landscape”. Neurological Sciences 10 (2021): 4017-4027.
  12. Ahmad S., et al. “Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: An open randomised trial”. The Lancet9522 (2006): 1591-1597.
  13. Seizure first aid and safety (2021).
  14. Ashrafi MR., et al. “Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children”. European Journal of Paediatric Neurology 5 (2010): 434-438.
  15. Riva A., et al. “Intramuscular midazolam for treatment of status epilepticus”. Expert Opinion on Pharmacotherapy1 (2021): 37-44.
  16. Kapur J., et al. “Randomized trial of three anticonvulsant medications for status epilepticus”. New England Journal of Medicine 22 (2019): 2103-2113.
  17. Kellinghaus C., et al. “Factors predicting cessation of status epilepticus in clinical practice: data from a prospective observational registry (SENSE)”. Annals of Neurology 3 (2019): 421-432.
  18. Chamberlain JM., et al. “Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomized controlled trial”. Lancet 10231 (2020): 1217-1224.
  19. Crawshaw AA and Cock HR. “Medical management of status epilepticus: emergency room to intensive care unit”. Seizure 75 (2020): 145-152.
  20. Dalziel SR., et al. “Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial”. Lancet 10186 (2019): 2135-2145.
  21. Silbergleit R., et al. “Intramuscular versus intravenous therapy for prehospital status epilepticus”. New England Journal of Medicine7 (2012): 591-600.
  22. Anderson M. “Buccal midazolam for pediatric convulsive seizures: efficacy, safety, and patient acceptability”. Patient Preference and Adherence 7 (2013): 27-34.
  23. McMullan J., et al. “Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta‐analysis”. Academic Emergency Medicine 6 (2010): 575-582.
  24. Welch RD., et al. “Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population”. Epilepsia2 (2015): 254-262.
  25. Roger J. “Status epilepticus”. Handbook of Clinical Neurology 15 (1974): 145-188.
  26. Shah I and Deshmukh C. “Intramuscular midazolam vs intravenous diazepam for acute seizures”. Indian Journal of Pediatrics 8 (2005): 667-670.

Afsheen Batool Raza., et al. "Frequency of Successful Outcome of Intramuscular Midazolam for the Treatment of Status Epilepticus in Children". EC Paediatrics 13.6 (2024): 01-06.