Acute Seizure Control in Pediatric Patients: Intranasal Midazolam vs. Intravenous/Rectal Benzodiazepines
Introduction
Acute seizure activity may be associated with complications including bodily harm, progression to status epilepticus, and poor quality of life in children. Moreover, difficulties in introducing a venous line in children with seizures may further delay the treatment initiation. Rectal drug administration may lead to a socially awkward situation for patients as well as the treatment providers. Intranasal (IN) midazolam, with easier and faster administration may offer a valuable substitute in such situations.
Aim
To compare the efficacy, safety, and acceptability of IN midazolam with conventional IV or rectal benzodiazepine (BDZ) in children with acute seizure.
Profile of the Studies included in the Meta-analysis
- Randomized controlled trials (RCTs) or prospective randomized trials comparing IN midazolam against IV/rectal BDZ for the treatment of pediatric patients who presented with acute seizures
Methods
Study Design
- A systematic review and meta-analysis
Results
- Overall, 10 studies providing data of 737 seizure episodes were included in this systematic review and meta-analysis.
- Intranasal midazolam (n=169) vs. IV/rectal BDZ (n=161) had a shorter interval between hospital arrival and seizure cessation {(mean difference = -3.51; 95% CI [-6.84, -0.18]) P=0.04}.
- The time to seizure cessation did not differ significantly following midazolam (n=326) or BDZ (n=322) (mean difference: -0.03; 95% CI: -1.30, 1.25); P=0.97). Both the drugs were equally effective for controlling acute seizures (odds ratio; 1.06; 95% CI: 0.43, 2.63).
Conclusion
- Amongst children with acute seizures, IN midazolam was as effective as IV/rectal BDZ in aborting seizure and decreasing the total time from hospital arrival and cessation of seizures, eventually leading to faster cessation of seizure.
- IN midazolam reduced risks and limitations associated with IV route and may thus be a promising treatment option for pediatric patients to be used in clinic and pre-hospital setting.
Epilepsy Behav. 2021 Nov 2 (Published Online);125:108390. doi: 10.1016/j.yebeh.2021.108390.
