Nasal Midazolam to Terminate Seizures

Source: O’Regan M, et al. Nasal rather than rectal benzodiazepines in the management of acute seizures? Dev Med Child Neurol 1996;38:1037-1045.

Rectally administered benzodiazepines are sometimes useful to terminate seizures in children. Embarrassment, however, limits use of this approach in adults and older children, particularly in the school setting. Furthermore, caregivers in residential facilities for the disabled may be reluctant to administer medications rectally. O’Regan and colleagues now report that intranasal midazolam is a safe and effective alternative to rectal diazepam.

The authors treated 19 children with severe epilepsy with one or two doses of midazolam 0.2 mg/kg dripped into the nose. Vital signs, EEG, EKG, oxygen saturation, and clinical condition were monitored. Three children had on-going clinical seizure activity stopped by the midazolam. In 12 others, continuous epileptiform activity on the EEG disappeared. The only side effect was a fall in oxygen saturation to 87% in one patient.

Intranasal midazolam may represent a safe and effective alternative to rectal diazepam for terminating seizures in an outside-the-hospital setting. A larger, controlled trial treating more actively seizing patients may prove informative. —drl