Effects of Intranasal Midazolam and Rectal Diazepam on Acute Convulsions in Children: Prospective Randomized Study

Abstract

In this study, the effects and side effects of rectal diazepam and intranasal midazolam were compared in the treatment of acute convulsions in children to develop a practical and safe treatment protocol. In the diazepam group, the seizures of 13 (60%) patients terminated in 10 minutes; however, 9 (40%) patients did not respond. In the midazolam group, 20 (87%) patients responded in 10 minutes, but 3 (13%) patients did not respond. Regarding the anticonvulsant effect, midazolam was found to be more effective than diazepam, and the difference was statistically significant (P < .05). The necessity of a second drug for the seizures that did not stop with the first drug was higher in the diazepam group than the midazolam group, and the difference was statistically significant (P < .05). We conclude that as an antiepileptic agent, intranasal midazolam is more effective than rectal diazepam. After administration, we did not observe any serious complications. Further investigations are necessary; however, intranasal administration is easy, so if the nasal drop and spray forms used in some European countries and the United States are available worldwide, it will be very useful for physicians in the emergency room.

Buccal Clonazepam versus Intravenous (I/V) Midazolam for Management of Acute Breakthrough Seizure –A Randomized Controlled Trial

“…Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

“…Rectal diazepam emerged as the primary treatment option for breakthrough seizures in the past. However rectal diazepam has slower onset of action than the intravenously delivered drug and is not as effective at controlling seizures (10).Other disadvantages include low social acceptability and high cost of the commercial preparation [10][11][12].Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

“…A single dose of midazolam administered by hospital personnel provided a positive response in 13 patients (81.8%), all of whom stopped seizing in less than 5 minutes and experienced no reoccurrence. Of those 13 (Table). 1,8,12,13 Bhattacharyya and colleagues 12 compared intranasal midazolam to rectal diazepam in 46 children who presented to the ED with febrile or afebrile seizures.…”

“…Of those 13 (Table). 1,8,12,13 Bhattacharyya and colleagues 12 compared intranasal midazolam to rectal diazepam in 46 children who presented to the ED with febrile or afebrile seizures. Baseline characteristics were similar between the 2 groups.…”

“…Prospective and retrospective evidence shows that intranasal midazolam terminates seizures at least as fast as rectal diazepam. 1,5,8,[12][13][14][15] Most clinical studies have used a 5 mg/mL midazolam solution dosed at 0.2 mg/ kg (divided into each nostril) administered via an intranasal mucosal atomization (IN-MADD) device or nasal dropper as suggested by Kyrkou and colleagues. 16 Three open-labeled studies prospectively evaluated the time to seizure cessation with a dose of nasal midazolam (Table).…”