Use of midazolam for refractory status epilepticus in pediatric patients.
Status epilepticus is more common among children than young adults. Children might be less likely to die and might be resistant to permanent neurologic damage due to status epilepticus, but significant sequelae also have been demonstrated. Aggressive intervention and rapid termination of seizures contribute significantly to better prognosis and reduced mortality from status epilepticus. Initial treatment of status epilepticus typically consists of either diazepam or lorazepam, immediately followed by phenytoin or phenobarbital. However, approximately 100% to 15% of status epilepticus episodes are refractory to these conventional therapies. Traditionally, refractory status epilepticus is treated with barbiturate coma or general anesthetics, both of which require invasive cardiorespiratory and hemodynamic monitoring and are associated with significant complications. Midazolam is a water-soluble benzodiazepine with a fast onset of action, a short half-life, and inactive metabolites that has been very effective in terminating seizures refractory to diazepam, lorazepam, phenytoin, and phenobarbital in pediatric patients. Midazolam is a valuable treatment option for refractory status epilepticus, especially in pediatric patients.
Pellock
J M
JM
Division of Child Neurology, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298-0211, USA.
D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance; D006801:Humans; D008874:Midazolam / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012008:Recurrence; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D008874:Midazolam