High-dose midazolam therapy for refractory status epilepticus in children.
OBJECTIVE
To assess the efficacy of high-dose midazolam in the treatment of refractory status epilepticus in children.


METHODS
Paediatric intensive care unit (PICU).


METHODS
Audit of clinical experience.


METHODS
Seventeen consecutive patients treated for episodes of refractory status epilepticus.


METHODS
Algorithm-driven administration of intravenous midazolam to control RSE. Regular, mandatory, patient evaluation to avoid delay in the appropriate escalation of therapy. Our target was the abolition of clinical seizures within 30 min of initiating treatment and early confirmation of cessation of all seizure activity using EEG. The algorithm had failed if clinical seizures persisted beyond 30 min despite the administration of midazolam at 24 microg/kg/min or if administration of a further acute anti-epileptic drug was required to achieve seizure control.


METHODS
The midazolam infusion rate, cumulative midazolam dose and duration of midazolam therapy at time of clinical seizure control were recorded. Haemodynamic parameters were recorded continuously. Episodes of algorithm failure, breakthrough seizures and seizure relapses were identified. Patient outcome was measured in terms of survival to PICU discharge.


RESULTS
In 13 patients (76%) midazolam achieved clinical seizure control within 30 min of treatment initiation. Midazolam was eventually successful in treating 15 seizure episodes (88%). Breakthrough seizures occurred in 8 patients (47%). Relapse after discontinuation of therapy occurred in 1 patient (6%). No significant adverse effects attributable to the use of midazolam occurred. There were 3 deaths (18%) related to underlying CNS pathology.


CONCLUSIONS
Midazolam can offer control of refractory status epilepticus without significant morbidity.
Morrison
Gavin
G
Department of Paediatric Intensive Care Medicine, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK. gavin.morrison@bch.nhs.uk
Gibbons
Elizabeth
E
Whitehouse
William Patrick
WP
D000293:Adolescent; D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D013226:Status Epilepticus / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors
D000927:Anticonvulsants; D006993:Hypnotics and Sedatives; D008874:Midazolam