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

Mpimbaza, Arthur; Ndeezi, Grace; Staedke, Sarah G.; Rosenthal, Philip J.; Byarugaba, Justus

doi:10.1542/peds.2007-0930

Cited by 131 publications

(144 citation statements)

References 30 publications

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“…[2][3][4] Our results are comparable to those reported in the literature assessing the use of midazolam for seizure control in the emergency setting and reporting success rates of 56 to 96.7%. 3,5,8,10,11,[13][14][15][16][17] To our knowledge, there are no studies comparing IV midazolam to either lorazepam or diazepam IV in the ED setting. Silbergleit and colleagues published a double-blind, randomized, noninferiority trial comparing the efficacy of IM midazolam to that of IV lorazepam: IM midazolam was at least as safe and effective as IV lorazepam.…”

Section: Discussionmentioning

confidence: 99%

“…12 Multiple studies have proven that midazolam is at least as effective as diazepam in terms of safety and risk of recurrence, with the advantage of providing a faster initiation of treatment, leading to more rapid seizure cessation. 3,5,8,10,11,[13][14][15][16][17][18][19] Midazolam has emerged as a highly efficacious drug in the treatment of impending SE, with several routes of administration exhibiting high bioavailability. 19 In a recent article proposing evidence-based and expert consensus practice guidelines, the Neurocritical Care Society lists midazolam as Class I, Level A for the emergent treatment of SE, as Class IIB, Level B for urgent treatment (continuous infusion), and as Class IIa, Level B for refractory treatment using the evidence rating system of the American Heart Association. )…”

mentioning

confidence: 99%

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Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Tourigny-Ruel

Diksic

Mok

et al. 2014

CJEM

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Objective: To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age. Methods: This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011 In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications. Results: Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis. Conclusion: This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children. RÉ SUMÉObjectif: L'é tude visait à é valuer l'efficacité et l'innocuité d'un simple protocole liné aire, fondé sur le midazolam, pour le traitement d'un é tat de mal é pileptique imminent, chez des enfants â gé s de 18 ans et moins.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Tourigny-Ruel

Diksic

Mok

et al. 2014

CJEM

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“…60,61 Comparatively, buccal midazolam also resulted in a greater reduction in the likelihood of seizure recurrence 1 hour after administration, with no difference in respiratory arrest or depression.…”

Section: Therapy: IV Vs Non-iv Treatmentmentioning

confidence: 93%

“…13,51,53,55,58,59 In general, investigators have shown that while benzodiazepines delivered via an IV have a more rapid onset of action from dose delivery to seizure cessation, a greater amount of time is required to place the IV than to deliver the therapy by non-IV routes. 13,55,59,60,61 Therefore, the total amount of time from the decision to treat with a benzodiazepine to seizure cessation is equivalent or less when alternative routes are used. Specifically, this has been shown for midazolam when delivered by the IM, IN, or buccal routes.…”

Section: Therapy: IV Vs Non-iv Treatmentmentioning

confidence: 99%

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An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Shah¹,

Macias²,

Dayan³

et al. 2013

Prehospital Emergency Care

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Objective. The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence. Methods. A multidisciplinary panel was chosen based on expertise in pediatric emergency medicine, prehospital medicine, and/or evidence-based guideline development. The panel followed the National Prehospital EBG Model using the GRADE methodology to formulate questions, retrieve evidence, appraise the evidence, and formu- The panel finalized a draft of a patient care algorithm in 2012 that was presented to stakeholder organizations to gather feedback for necessary revisions. Results. Five strong and ten weak recommendations emerged from the process; all but one was supported by low or very low quality evidence. The panel sought to ensure that the recommendations promoted timely seizure cessation while avoiding respiratory depression and seizure recurrence. The panel recommended that all patients in an active seizure have capillary blood glucose checked and be treated with intravenous (IV) dextrose or intramuscular (IM) glucagon if <60 mg/dL (3 mmol/L). The panel also recommended that non-IV routes (buccal, IM, or intranasal) of benzodiazepines (0.2 mg/kg) be used as first-line therapy for status epilepticus, rather than the rectal route. Conclusions. Using GRADE methodology, we have developed a pediatric seizure guideline that emphasizes the role of capillary blood glucometry and the use of buccal, IM, or intranasal benzodiazepines over IV or rectal routes. Future research is needed to compare the effectiveness and safety of these medication routes.

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Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

Holsti¹,

Dudley²,

Schunk³

et al. 2010

Arch Pediatr Adolesc Med

131

127

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Objective: To compare intranasal midazolam, using a Mucosal Atomization Device (IN-MMAD), with rectal diazepam (RD) for the home treatment of seizures in children with epilepsy.Design: Prospective randomized study.Setting: Patients' homes and a freestanding children's hospital that serves as a referral center for 5 states.Patients: A total of 358 pediatric patients who visited a pediatric neurology clinic from July 2006 through September 2008 and were prescribed a home rescue medication for their next seizure.Intervention: Caretakers were randomized to use either 0.2 mg/kg of IN-MMAD (maximum, 10 mg) or 0.3 to 0.5 mg/kg of RD (maximum, 20 mg) at home for their child's next seizure if it lasted more than 5 minutes.Outcome Measures: The primary outcome measure was total seizure time after medication administration. Our secondary outcome measures were total seizure time, time to medication administration, respiratory complications, emergency medical service support, emergency department visits, hospitalizations, and caretakers' ease of administration and satisfaction with the medication.Results: A total of 92 caretakers gave the study medication during a child's seizure (50 IN-MMAD, 42 RD). The median time from medication administration to seizure cessation for IN-MMAD was 1.3 minutes less than for RD (95% confidence interval, 0.0-3.5 minutes; P=.09). The median time to medication administration was 5.0 minutes for each group. No differences in complications were found between treatment groups. Caretakers were more satisfied with IN-MMAD and report that it was easier to give than RD. Conclusions:There was no detectable difference in efficacy between IN-MMAD and RD as a rescue medication for terminating seizures at home in pediatric patients with epilepsy. Ease of administration and overall satisfaction was higher with IN-MMAD compared with RD.

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

Abstract: Buccal midazolam was as safe as and more effective than rectal diazepam for the treatment of seizures in Ugandan children, although benefits were limited to children without malaria.

Cited by 131 publications

References 30 publications

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology

Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric Patients With Epilepsy

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