Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status epilepticus.
OBJECTIVE
Continuous midazolam infusion is commonly used for the management of status epilepticus (SE). The purpose of this study was to assess the efficacy of midazolam and mortality in childhood refractory generalized convulsive SE.


METHODS
We included 27 children with refractory generalized convulsive SE. Midazolam was given 0.2 mg/kg as bolus, followed by 1-5 microg/kg/min as continuous infusion. Clinical data and response to treatment were recorded for each patient.


RESULTS
Acute symptomatic SE accounted for 52%, and central nervous system (CNS) infections were the most frequently associated etiologic condition (44%). Complete control of seizures was achieved with midazolam infusion in the 26 (96%) children within 65 min; at a mean midazolam infusion rate of 3.1 microg/kg/min. Adverse effects such as hypotension, bradycardia or respiratory depression did not occur during midazolam infusion. In one (4%) patient with acute meningoencephalitis, SE could not be controlled. Five (19%) patients died; four had acute symptomatic aetiology and one had progressive encephalopathy.


CONCLUSIONS
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.
Ozdemir
Durgul
D
Dokuz Eylul University, School of Medicine, Department of Paediatrics, Izmir, Turkey. durgulozdemir@yahoo.com
Gulez
Pamir
P
Uran
Nedret
N
Yendur
Gurol
G
Kavakli
Tulay
T
Aydin
Adem
A
D000293:Adolescent; D001919:Bradycardia / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000139:chemically induced; D013226:Status Epilepticus / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
D006993:Hypnotics and Sedatives; D008874:Midazolam