Intravenous midazolam in convulsive status epilepticus in children with pharmacoresistant epilepsy.
Although the efficacy of midazolam in refractory status epilepticus and as a first-line agent in children with established status epilepticus has been reported, differences in starting doses, continuation method, timing of efficacy assessment, and discontinuation pose limitations in deriving a specific protocol for midazolam use. An audit of clinical experience with a protocol of midazolam as first-line agent for impending status epilepticus (defined as a continuous, generalized, convulsive seizure lasting >5 minutes) in 76 episodes of unprovoked convulsive status epilepticus in children 1-15 years old with treatment-refractory epilepsy demonstrated that: (1) repeated bolus midazolam 0.1mg/kg (every 5 minutes, maximum 5) controlled 91% of events; (2) three bolus doses controlled 89% of the episodes, with minimal chance of response beyond that; (3) treating impending status resulted in lower doses (mean 0.17 mg/kg) than reported and infrequent utilization of additional anticonvulsants (9%); and (4) adverse events were infrequent (respiratory depression 13%, assisted ventilation 3%).
Papavasiliou
Antigone S
AS
Department of Pediatric Neurology, Pendeli Children's Hospital, 8 Mandelara Street, Nea Erythraia, Athens, Greece. theon@otenet.gr
Kotsalis
Charalambos
C
Paraskevoulakos
Evangelos
E
Karagounis
Panagiotis
P
Rizou
Chrysoula
C
Bazigou
Helene
H
D000293:Adolescent; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D007276:Injections, Intraventricular / Q000379:methods; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D008874:Midazolam