الفهرس 
MidazolamOnly 14 pages are availabe for public view
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Abstract
S
tatus Epilepticus (SE) is a common pediatric emergency which is potentially life-threatening and requires rapid termination. Management focuses on early administration of anti-seizure medications that are typically given outside of the hospital. Clearly, morbidity and mortality, the intensity of health-care resources and expenses associated with treatment of patients with epilepsy could be reduced if an effective and safe treatment was available for use by caregivers.
Midazolam as an anti-seizure medication can be given intravenously, intramuscularly, and buccaly, as well as via the nasal mucosa. In this study we wished to address the difference between the three routes of midazolam administration, IM, buccal and intranasal regarding efficacy to abort seizure and the overall satisfaction by ER doctors and caregivers.
Three hundred and five patients resulted eligible for the study. One hundred ninety six patients were randomized to home treatment constituting 196 seizure episodes (60 randomized to nasal, 67 buccal and 69 intramuscular) and one hundred seven in ER group constituting 107 seizure episodes (34 randomized to nasal, 37 buccal and 34 intramuscular). The interview was completed for 105 patients from the ER group and 196 seizure episodes from home group.
Therapeutic success of intramuscular midazolam was achieved in 94.2 % in home group and 85.3 % in ER group. Intranasal route therapeutic success was achieved in 93.3% in home group and 88.2 % in ER group. Buccal midazolam achieved therapeutic success in 91% of home group and 78.4 % in ER with no significant difference in efficacy between all three groups. Time to seizure cessation was significantly higher in buccal midazolam as compared to intramuscular and intranasal midazolam. Highest overall satisfaction level and ease of administration was seen in intranasal group especially among caretakers in home group. Intramuscular midazolam was more preferred by physicians in ER group. There were no significant adverse events in all groups.