A Comparison of Buccal Midazolam and Rectal Diazepam for the Acute Treatment of Seizures

Abstract

In this study, the authors aimed to evaluate buccal midazolam as a practical and safe alternative medication for children who suffer from seizures in the emergency setting and in home practice or anywhere. The effects and side effects of buccal midazolam and rectal diazepam were compared in the treatment of acute convulsions in 43 children, ranging in age from 2 months to 12 years who were seen at the emergency service of the children hospital. Midazolam was given on the even days of the month and diazepam was given on the odd days. In the midazolam group, the seizures of 18/23 (78%) patients terminated in 10 minutes; however 5/23 (22%) patients did not respond. In the diazepam group 17/20 (85%) patients responded in 10 minutes, but 3/20 (15%) did not respond. Midazolam was found to be as effective as diazepam and the difference was not statistically significant (p<0.05). Response periods of the 2 drugs showed no significant difference (p>0.05). The need for a second drug for seizures that did not stop with the first drug was equal, and the difference was not statistically significant (p>0.05). They did not observe any serious complications. In conclusion, buccal midazolam is safe and as effective as rectal diazepam for the treatment of seizures.

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

“…Respiratory depression after rectal administration of diazepam in children was reported in five class III trials, ranging from 1.2 percent to 6.4 percent (35,41,42,45,47), while two class III trials (37,40) and two class I trials in acute repetitive seizures (59,60) reported no incidence of respiratory depression with rectal diazepam use in children. No respiratory depression was reported in one study of six children treated with rectal lorazepam (35).…”

Comparison of Buccal Midazolam With Rectal Diazepam in the Treatment of Prolonged Seizures in Ugandan Children: A Randomized Clinical Trial

“…18 Buccal midazolam has been found to be as effective as rectal diazepam in control of seizures in developed countries. 19,20 Recently, in a randomized, controlled trial, buccal midazolam was as safe as and more efficacious than rectal diazepam for the treatment of seizures in children who presented to hospitals in Great Britain. 21 Potential advantages of buccal midazolam over rectal diazepam include improved efficacy, at least in developed countries, ease of administration, and safety.…”

Controlling Seizures in Children: Diazepam or Midazolam? Systematic Review

“…[17][18][19][20] Seizure recurrence was significantly less common in children treated with midazolam than diazepam, in the two studies reporting on it. 17,18 In all studies, respiratory depression was uncommon in either treatment group.…”