title: Buccal Midazolam Compared With Rectal Diazepam Reduces Seizure Duration in Children in the Outpatient Setting.
abstract: BACKGROUND
  Seizures are very common in children. They frequently happen in outpatient settings, in the presence of caregivers who are not always trained in their management. First-line rescue therapy is based on benzodiazepine, historically diazepam. Recent studies have investigated the use of other benzodiazepines in the treatment of acute seizures.
  
  
  OBJECTIVE
  The aims of this study were to evaluate the management of pediatric seizures carried out by parents or caregivers in an outpatient setting and to evaluate the differences in terms of immediate management and subsequent outcome when comparing the use of rectal diazepam versus buccal midazolam.
  
  
  METHODS
  In this retrospective study, medical records of children consulting for seizures at the Robert Debré Pediatric Emergency Department of Paris, France, over 18 months were analyzed to evaluate seizure characteristics, management by caregivers, received treatments, and the admission rate.
  
  
  RESULTS
  Five hundred ninety-four patients resulted eligible for the study. The interview was completed for 135 children who presented a further episode of seizure after inclusion. In the subgroup of children receiving buccal midazolam, compared with the subgroup receiving intrarectal diazepam, seizure duration was significantly shorter (10.3 vs 48.4 minutes, P = 0.0004), and the risk of a status epilepticus decreased (1 vs 11, P = 0.0008). The admission rate was not different between the 2 subgroups.
  
  
  CONCLUSIONS
  Based on our results, buccal midazolam seems to have some advantages compared with rectal diazepam in terms of feasibility in an outpatient setting and in terms of reduced seizure duration.
authors.affiliation: From the Pediatric Emergency Department.|Physiology Department, APHP, Robert Debre Hospital.|INSERM U1141, DHU PROTECT, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Pediatric Department, Università degli Studi di Udine, Udine, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Moretti
authors.affiliation: Pre-Hospital Care Unit, SMUR Pédiatrique, Robert Debre Hospital, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Julliand
authors.affiliation: From the Pediatric Emergency Department.
authors.forename: Victoria Elisa
authors.initials: VE
authors.lastname: Rinaldi
authors.affiliation: From the Pediatric Emergency Department.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
mesh_terms: D000278:Administration, Buccal; D000285:Administration, Rectal; D000553:Ambulatory Care / Q000379:methods; D000927:Anticonvulsants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D003975:Diazepam; D008874:Midazolam