title: Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial.
abstract: OBJECTIVE
  To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Pediatric emergency department.
  
  
  METHODS
  Children aged 2 months to 14 years admitted to the study facility with seizures.
  
  
  METHODS
  Patients were randomized to receive DZP-IV or MDZ-IM.
  
  
  METHODS
  Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5min of drug administration.
  
  
  RESULTS
  Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4min; p<0.001 and 7.3 versus 10.6min; p=0.006, respectively). In two children per group (12.5%), seizures continued after 10min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events (p=0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group.
  
  
  CONCLUSIONS
  Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.
authors.affiliation: Pediatric Emergency Department, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria (UFSM), Av. Roraima, Prédio 22, Campus, Bairro Camobi, Zip Code: 97105 900, Santa Maria, RS, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: J L
authors.initials: JL
authors.lastname: Portela
authors.affiliation: Department of Pediatrics, School of Medicine, PUCRS, Brazil; Hospital São Lucas, PUCRS, Porto Alegre, RS, Brazil. Electronic address: celiny@pucrs.br.
authors.forename: P C R
authors.initials: PC
authors.lastname: Garcia
authors.affiliation: Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: J P
authors.initials: JP
authors.lastname: Piva
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Pediatric Emergency Department, Hospital Universitário de Santa Maria, UFSM, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Barcelos
authors.affiliation: Department of Pediatrics, School of Medicine, PUCRS, Brazil; Hospital São Lucas, PUCRS, Porto Alegre, RS, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Pediatric Intensive Care Locum Consultant, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: R
authors.initials: R
authors.lastname: Branco
authors.affiliation: Pediatric NeuroCritical Care Program, CHMC, Boston, USA; Harvard Medical School, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Tasker
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007223:Infant; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced; D010372:Pediatrics; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D003975:Diazepam; D008874:Midazolam
keywords: Benzodiazepines; Benzodiazepínicos; Convulsiones; Epilepsia; Epilepsy; Estado epiléptico; Seizures; Status epilepticus