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Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study
Eli Lahat a Pediatric Neurology Unit, Assaf Harofeh Medical Center,
Zerifin 70300, Israel, b Department of Pediatrics, Assaf Harofeh Medical
Center, c Pediatric Intensive Care Unit, Assaf
Harofeh Medical Center, d Pediatric Clinical Pharmacology Unit, Assaf Harofeh Medical
Center
Correspondence to: E Lahat shiri{at}gezernet.co.il
Objective:
To compare the safety and efficacy of
midazolam given intranasally with diazepam given intravenously in the
treatment of children with prolonged febrile seizures.
Design:
Prospective randomised study.
Setting:
Paediatric emergency department in a general hospital.
Subjects:
47 children aged six months to five years with prolonged febrile seizure (at least 10 minutes) during a 12 month period.
Interventions:
Intranasal midazolam (0.2 mg/kg) and
intravenous diazepam (0.3 mg/kg).
Main outcome measures:
Time from arrival at hospital
to starting treatment and cessation of seizures.
Results:
Intranasal midazolam and intravenous diazepam were equally effective. Overall, 23 of 26 seizures were controlled with
midazolam and 24 out of 26 with diazepam. The mean time from arrival at
hospital to starting treatment was significantly shorter in the
midazolam group (3.5 (SD 1.8) minutes, 95% confidence interval 3.3 to
3.7) than the diazepam group (5.5 (2.0), 5.3 to 5.7). The mean time to
control of seizures was significantly sooner (6.1 (3.6), 6.3 to 6.7) in
the midazolam group than the diazepam group (8.0 (0.5), 7.9 to 8.3). No
significant side effects were observed in either group.
Conclusion:
Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam, although midazolam
was as safe and effective as diazepam. The overall time to cessation of
seizures after arrival at hospital was faster with intranasal midazolam
than with intravenous diazepam. The intranasal route can possibly be
used not only in medical centres but in general practice and, with
appropriate instructions, by families of children with recurrent
febrile seizures at home.
© BMJ 2000
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