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Increased Prehospital Midazolam Use for Seizures Might Be Endangered

Guidelines recommend intramuscular midazolam for status epilepticus patients who experience seizures and, according to a new study, the benzodiazepine is increasingly being administered in prehospital care before the patients arrives at the emergency department.

The question is whether that situation – based on previous research on the drug’s effectiveness for seizures – will be able to continue.

When someone experiences a seizure and an ambulance responds, emergency personnel tend to treat the person with a benzodiazepine if the seizure is continuing when they arrive, explained William Meurer, MD, associate professor of emergency medicine at Michigan Medicine. One type of benzodiazepine that can be used is midazolam.

Meurer is the senior author on a new study published on PLOS One that looks at how use of midazolam has increased in the wake of 2012 research on its greater efficacy as a seizure treatment.

Results of the RAMPART clinical trial were published in the New England Journal of Medicine in 2012, maintaining that midazolam was more effective in treating seizures than other benzodiazepines, and could be used more quickly because it can be injected and doesn’t require intravenous administration.


Using data from the National Emergency Medical Services Information System, a national repository of standardized patient care reports from EMS agencies across the country, recent researchers compared data from Jan. 1, 2010, to Dec. 31, 2014 – two years before and after results of RAMPART were published.

Focusing on 156,539 seizures treated with benzodiazepines, the study team determined midazolam use increased from 26.1% in January 2010 to 61.7% percent in December 2014.

Overall, the odds of a patient receiving midazolam were 24% percent higher after the RAMPART study’s publication, results indicate.

But there is a potential problem looming, the study notes, because the drug is also used for lethal injections to carry out death penalties. The notoriety of using midazolam for that purpose could discourage drug companies from producing it if they aren’t making enough money to outweigh the negative public perception, Meurer pointed out.

The hope is that information about benefits for patients will keep it available, unlike other lethal injection drugs, Meurer noted. Midazolam can be markedly beneficial to patients undergoing seizures, he added.