Buccal midazolam for treatment of prolonged seizures in children

• Published in: Brain & development (Tokyo. 1979) 2003-06, Vol.25 (4), p.275-278
• Main Authors: Kutlu, Nurettin Onur, Dogrul, Mehmet, Yakinci, Cengiz, Soylu, Hanifi
• Format: Article
• Language: English
• Subjects: Administration, Buccal; Adolescent; Anticonvulsants - administration & dosage; Biological and medical sciences; Buccal; Child; Child, Preschool; Drug Administration Schedule; Emergency; Epilepsy - drug therapy; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Infant; Male; Medical sciences; Midazolam; Midazolam - administration & dosage; Nervous system (semeiology, syndromes); Neurology; Seizure; Seizures - drug therapy; Time Factors; Treatment Outcome
• ISSN: 0387-7604; 1872-7131
• DOI: 10.1016/s0387-7604(02)00230-9

Midazolam is a relatively new anticonvulsive agent in the benzodiazepine group. It has a short onset of duration and is practical for use, providing several alternatives such as intravenous, intramuscular, and intranasal routes. The buccal route could be an alternative choice for seizure control in an emergency setting. However, no sufficient reports are available on buccal midazolam administration. The present study was designated to examine the efficacy of buccal midazolam in children at different ages with seizures of more than 5 min duration. Nineteen previously unreported children, aged from 1 month to 15 years, were treated with a 0.3 mg/kg dose of buccal midazolam; 13 had prolonged seizures, and six had status epilepticus, with a duration of 5–45 min (mean 22 min). Sixteen of 19 seizures (84.2%) stopped within 10 min of buccal midazolam being given. The drug efficacy in patients with status epilepticus was 50%. However, all patients with convulsions shorter than 30 min showed a perfect response (100%). Convulsion episodes stopped within 3.89±2.22 min (median time 3 min). Seizure duration was correlated with cessation of seizure ( r=0.76, P