Controlling seizures in the prehospital setting: diazepam or midazolam?

Abstract

OBJECTIVE:

To determine which is the most effective and safe treatment for controlling seizures in children out-of-hospital: diazepam or midazolam.

METHODS:

A retrospective review of the medical records of children presenting to the Emergency Department of the Children's Hospital at Westmead (CHW-ED) with seizures requiring treatment in the field by paramedics was carried out over a 4-year period (April 1996 to March 2000). In New South Wales, children with seizures in the prehospital setting received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March 1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg i.v. midazolam. The main outcome measured was cessation of seizure in the prehospital setting. Secondary outcomes were time taken to initiate treatment and the frequency of cardiorespiratory compromise.

RESULTS:

Over the 4-year period, 2566 children presented to CHW-ED with a seizure; 107 children were eligible for entry into the present study. Of these 107 patients, 62 received diazepam and 45 received midazolam. Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam group were febrile seizures. Both groups were similar in terms of demographics and seizure type. A comparison of diazepam with midazolam showed that both drugs were effective in stopping seizures within 5 min of drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group suffered apnoea (20.0% cf. 29.0%; P < 0.05).

CONCLUSION:

Midazolam controls seizures as effectively as diazepam in the prehospital setting. Furthermore, midazolam potentially reduces respiratory depression and time to treatment.

• Authors: J Rainbow, G J Browne, L T Lam
• Journal: Journal of paediatrics and child health (J Paediatr Child Health) Vol. 38 Issue 6 Pg. 582-6 (Dec 2002) ISSN: 1034-4810 [Print] Australia
• PMID: 12410871 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anticonvulsants
• GABA Modulators
• Diazepam
• Midazolam

Topics

• Anticonvulsants (adverse effects, therapeutic use)
• Child
• Child, Preschool
• Diazepam (adverse effects, therapeutic use)
• Emergency Medical Services
• Female
• GABA Modulators (adverse effects, therapeutic use)
• Humans
• Infant
• Male
• Midazolam (adverse effects, therapeutic use)
• New South Wales
• Retrospective Studies
• Seizures (drug therapy)
• Treatment Outcome