Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: A randomized clinical trial

Portela, J.L.; García, Pedro Celiny Ramos; Piva, Jefferson Pedro; Barcelos, Andrea Lucia Machado; Bruno, Francisco; Branco, Ricardo Garcia; Tasker, RC

doi:10.1016/j.medine.2014.04.006

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…In all three studies, IM midazolam had a shorter interval to seizure cessation, but there was no significant difference in overall efficacy for termination of seizures (36,43,55).…”

Section: Pediatric Studiesmentioning

confidence: 86%

“…Intramuscular midazolam was compared with IV diazepam in three class III studies (36,43,55). In all three studies, IM midazolam had a shorter interval to seizure cessation, but there was no significant difference in overall efficacy for termination of seizures (36,43,55).…”

Section: Pediatric Studiesmentioning

confidence: 99%

“…Class III trials identified similar rates of respiratory depression with IV benzodiazepine use (35,49,55). One class III trial reported 21% of patients receiving IV diazepam and 4% of patients receiving IV lorazepam were reported to have respiratory depression defined as poor respiratory effort, reduced rate of breathing, or requiring oxygen administration via face mask (35).…”

Section: Pediatric Studiesmentioning

confidence: 99%

“…Two of the class III IM or intranasal midazolam studies reported significant respiratory depression (36-39, 43, 45, 46, 53). Single children in each study (6.25% and 2%) in the IM midazolam group experienced respiratory failure resulting in artificial ventilation (51,55).…”

Section: Pediatric Studiesmentioning

confidence: 99%

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

Glauser

Shinnar

Gloss³

et al. 2016

Epilepsy Curr

978

937

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CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists. STUDY SELECTION: Randomized controlled trials of anticonvulsant treatment for seizures lasting longer than 5 minutes. DATA EXTRACTION: Individual studies were rated using predefined criteria and these results were used to form recommendations, conclusions, and an evidence-based treatment algorithm. RESULTS: A total of 38 randomized controlled trials were identified, rated and contributed to the assessment. Only four trials were considered to have class I evidence of efficacy. Two studies were rated as class II and the remaining 32 were judged to have class III evidence. In adults with convulsive status epilepticus, intramuscular midazolam, intravenous lorazepam, intravenous diazepam and intravenous phenobarbital are established as efficacious as initial therapy (Level A). Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access (Level A). In children, intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes (Level A) while rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective (Level B). No significant difference in effectiveness has been demonstrated between intravenous lorazepam and intravenous diazepam in adults or children with convulsive status epilepticus (Level A). Respiratory and cardiac symptoms are the most commonly encountered treatment-emergent adverse events associated with intravenous anticonvulsant drug administration in adults with convulsive status epilepticus (Level A). The rate of respiratory depression in patients with convulsive status epilepticus treated with benzodiazepines is lower than in patients with convul-

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“…In all three studies, IM midazolam had a shorter interval to seizure cessation, but there was no significant difference in overall efficacy for termination of seizures (36,43,55).…”

Section: Pediatric Studiesmentioning

confidence: 86%

Section: Pediatric Studiesmentioning

confidence: 99%

Section: Pediatric Studiesmentioning

confidence: 99%

Section: Pediatric Studiesmentioning

confidence: 99%

See 2 more Smart Citations

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

Glauser

Shinnar

Gloss³

et al. 2016

Epilepsy Curr

978

937

View full text Add to dashboard Cite

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“…Prior studies compared different BZD types in terms of efficacy and routes of administration in pediatric acute seizures or SE. 18,[37][38][39] A study including 81 SE episodes showed that IV LZP and DZP were equally effective in stopping generalized seizures. 39 Moreover, a study evaluating LZP IV and DZP IV or PR demonstrated no difference between treatments regarding seizure cessation 40 ; however, patients with LZP IV required fewer doses to stop seizures than patients treated with DZP.…”

Section: Discussionmentioning

confidence: 99%

First-line medication dosing in pediatric refractory status epilepticus

et al. 2020

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Objective:To identify factors associated with low benzodiazepine (BZD) dosing in refractory status epilepticus (RSE) patients and to assess the impact of BZD treatment variability on seizure cessation.Methods:Retrospective study with prospectively collected data of children with convulsive RSE admitted between June 2011 and January 2019. We analyzed the initial and total BZD dose within 10 minutes of treatment initiation. We used logistic regression modeling to evaluate predictors of low BZD dosing, and multivariate Cox regression analysis to assess the impact of low BZD dosing on time to seizure cessation.Results:We included 289 patients (55.7% males) were included with a median age of 4.3 (1.3-9.5) years. BZDs were the initial medication in 278 (96.2%). Of those, 161 patients (57.9%) received a low initial dose. Low initial BZD doses occurred in both out-of-hospital (57/106; 53.8%) and in-hospital (104/172; 60.5%) settings. 103 patients (37.1%) received low total BZD dose. Males (OR 2; 95%CI 1.18-3.49; p=0.012), older age (OR 1.1; 95%CI 1.05-1.17; p<0.001), no prior diagnosis of epilepsy (OR 2.1; 95%CI 1.23-3.69; p=0.008), and delayed BZD treatment (OR 2.2; 95%CI 1.24-3.94; p=0.007), were associated with low total BZD dose. Patients who received low total BZD dosing were less likely to achieve seizure cessation (HR=0.7, 95%CI 0.57-0.95).Conclusion:BZD doses were lower than recommended in both out-of-hospital and in-hospital settings. Factors associated with low total BZD dose included male sex, older age, no prior epilepsy diagnosis, and delayed BZD treatment. Low total BZD dosing was associated with decreased likelihood of seizure cessation.Classification of Evidence:This study provides Class III evidence that patients with RSE who present with male sex, older age, no prior diagnosis of epilepsy, and delayed BZD treatment are more likely to receive low total BZD doses. This study provides Class III evidence that in pediatric refractory status epilepticus low total BZD dose decreases the likelihood of seizure cessation.

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Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability

et al. 2022

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Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA) A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.

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Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: A randomized clinical trial

Cited by 3 publications

References 26 publications

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

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

First-line medication dosing in pediatric refractory status epilepticus

Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability

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