Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status epilepticus

Özdemir, Durgül; Gülez, Pamir; Uran, Nedret; Yendur, Gürol; Kavakli, Tülay; Aydın, Adem

doi:10.1016/j.seizure.2004.12.005

Cited by 51 publications

(29 citation statements)

References 19 publications

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“…Complete control of seizures with midazolam infusion can be achieved in over 90% of children within an hour; at a mean infusion rate of 3 mg/kg/min. Adverse effects such as hypotension, bradycardia or respiratory depression are unlikely to occur during midazolam infusion [14]. If midazolam is not available, diazepam can be used.…”

Section: Refractory Status Epilepticus (Rse)mentioning

confidence: 99%

Status Epilepticus in Children

Behera

Rana

Kanitkar

et al. 2005

Medical Journal Armed Forces India

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Status epilepticus (SE) is a life-threatening emergency that requires prompt treatment, including basic neuroresuscitation principles (the ABCs), antiepileptic drugs to stop the seizure and identification of etiology. It results from an inability to normally abort an isolated seizure either due to ineffective inhibition, or due to abnormally persistent excessive excitation. Symptomatic SE is more common in younger children and the likely etiology depends on the age of the child. Treating the precipitating cause may prevent ongoing neurologic injury and facilitates seizure control. Benzodiapenes, phenytoin and phenobarbital form the mainstay of treatment. A systematic treatment regimen, planned in advance, is needed, including one for refractory status epilepticus (RSE

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Section: Refractory Status Epilepticus (Rse)mentioning

confidence: 99%

Status Epilepticus in Children

Behera

Rana

Kanitkar

et al. 2005

Medical Journal Armed Forces India

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“…It is metabolized in the liver and excreted by the kidneys. Encouraging results have been seen with midazolam infusion in refractory status epilepticus in children [34][35][36][37].…”

Section: Midazolam Infusionmentioning

confidence: 99%

Status Epilepticus

2010

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Status epilepticus is a common neurological emergency in childhood and associated with significant morbidity and mortality. Status epilepticus (SE) has been defined as continuous seizure activity lasting more than 30 min or 2 or more seizures in this duration without gaining consciousness between them. However, the operational definition has brought the time down to 5 min. Management can be broadly divided into initial stabilization, seizure termination, and evaluation and treatment of the underlying cause. Diagnostic evaluation and seizure control should be achieved simultaneously to improve outcome. Seizure termination is achieved by pharmacotherapy. Benzodiazepines are the first line drugs for SE. Commonly used drugs include lorazepam, diazepam, and midazolam. In children without an IV access, buccal or nasal midazolam or rectal diazepam can be used. Phenytoin as a second line agent is usually indicated when seizure is not controlled after one or more doses of benzodiazepines. If the seizures continue to persist, valproate, phenobarbitone or levetiracetam is indicated. Midazolam infusion is useful in refractory status epilepticus. Thiopentone, propofol or high dose phenobarbitone are considered for treatment of refractory status epilepticus. Prolonged SE is associated with higher morbidity and mortality. Long term neurological sequelae include epilepsy, behavioural problems, cognitive decline, and focal neurologic deficits.

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“…Die Eliminationshalbwertszeit liegt zwischen 1,5 und 3,5 h, sie kann bei älteren Menschen jedoch erheblich länger sein [43]. In vier Fallserien [28,89,124,163] wurde übereinstimmend zunächst ein Bolus von 0,15-0,2 mg/kg innerhalb von 5-10 min verabreicht. Dies entspricht etwa 1/2-2 Ampullen á 15 mg. Dann wurde mit einer kontinuierlichen Infusionsrate von 0,05-0,1 mg/kg/h begonnen, die ca.…”

Section: Benzodiazepineunclassified

“…Die mittlere maximale Infusionsrate lag zwischen 0,22 mg/kg/ h und 0,48 mg/kg/h. Die Dauer der Behandlung mit Midazolam betrug in drei Studien etwa eine Stunde [89,124,163]. In diesen Therapiestudien war der Anteil der Patienten mit idiopathischen oder durch Medikamentenüberdosis oder -entzug ausgelösten SE höher als in den meisten epidemiologischen Studien.…”

Section: Benzodiazepineunclassified

“…In diesen Therapiestudien war der Anteil der Patienten mit idiopathischen oder durch Medikamentenüberdosis oder -entzug ausgelösten SE höher als in den meisten epidemiologischen Studien. Zwei dieser Studien [89,124] hatten nur Kinder eingeschlossen, die per se aufgrund des hö-heren Anteils an idiopathischen generalisierten SE eine bessere Prognose haben. In einer anderen Studie mit dem höchsten Anteil an Patienten mit ungünstigen Risikofaktoren [28] waren im Mittel 20 h Behandlung erforderlich.…”

Section: Benzodiazepineunclassified

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Refractory status epilepticus

et al. 2006

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Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10-20/100,000 individuals. The overall mortality is about 10-20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.

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Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status epilepticus

Abstract: Midazolam is effective and safe in the control of refractory generalized convulsive SE. The response to treatment and mortality were related to the underlying aetiology.

Cited by 51 publications

References 19 publications

Status Epilepticus in Children

Status Epilepticus in Children

Status Epilepticus

Refractory status epilepticus

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