Controlling seizures in the prehospital setting: diazepam or midazolam?
OBJECTIVE
To determine which is the most effective and safe treatment for controlling seizures in children out-of-hospital: diazepam or midazolam.


METHODS
A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW-ED) with seizures requiring treatment in the field by paramedics was carried out over a 4-year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise.


RESULTS
Over the 4-year period, 2566 children presented to CHW-ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05).


CONCLUSIONS
Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.
Rainbow
J
J
Department of Emergency Medicine, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
Browne
G J
GJ
Lam
L T
LT
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000009:adverse effects / Q000627:therapeutic use*; D004632:Emergency Medical Services; D005260:Female; D018757:GABA Modulators / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D009517:New South Wales; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D016896:Treatment Outcome
D000927:Anticonvulsants; D018757:GABA Modulators; D003975:Diazepam; D008874:Midazolam