Intranasal Midazolam vs Rectal Diazepam in Acute Childhood Seizures

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

“…[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.…”

“…2 Diazepam, lorazepam, and midazolam have been studied in randomized, controlled trials, confirming their efficacy in treating SE in children. [5][6][7][8][9][10][11] Most seizure protocols used in emergency departments (EDs) list all three benzodiazepines as possible choices. Midazolam is known for its better pharmacokinetic properties.…”

“…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. )…”

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.…”