The effect of early midazolam infusion on the duration of pediatric status epilepticus patients.

PURPOSE: Status epilepticus is one of the most common neurological emergencies in pediatric emergency departments. Although there are different approaches to treatment in the literature, early control of seizure activity is the most important factor determining prognosis. The purpose of this study was to evaluate the effect of early midazolam infusion on seizure duration.

METHOD: This retrospective study included 150 episodes of 135 patients aged one month to 18 years old with status epilepticus. All patients were treated according to the local hospital protocol for SE, which included early midazolam infusion. Demographic data, medical history, applied treatments during SE, and seizure durations were recorded.

RESULTS: The median age of the patients (58.7% male) was 2.7 years (1.0-6.0 years). The most common identified etiologies were remote symptomatic etiologies, and generalized tonic-clonic seizure was the most common seizure type. The pediatricians had selected intravenous midazolam for 130 patients (86.7%) as the first-line therapy in emergency services. In 55 patients given continuous midazolam infusion, the cumulative bolus of midazolam was 0.5 mg/kg (0.4-0.7 mg/kg), and the median peak rate of midazolam infusion was 0.2 mg/kg/h (0.2-0.4 mg/kg/h). The median duration between the start of midazolam infusion and the complete cessation of SE was 15.0 min (9.0-25.0 min). The early-midazolam infusion group had shorter seizure duration after initiation of midazolam infusion (p = 0.020).

CONCLUSION: The current study shows that aggressive management of SE with early initiation of midazolam infusion was associated with a shorter seizure duration in SE patients.