>What do you think of IM midazolam (0.15-0.3mg/kg) as being the first
>drug-of-choice in the pre-hospital treatment or ED treatment of
>generalized convulsive seizures - rather than more traditional agents
>such as diazepam or lorazepam?
I think it's a great idea. Have you seen this study by Jim Chamberlain?
Pediatr Emerg Care 1997 Apr;13(2):92-4
A prospective, randomized study comparing intramuscular midazolam
with intravenous diazepam for the treatment of seizures in children.
Chamberlain JM, Altieri MA, Futterman C, Young GM, Ochsenschlager DW, Waisman
Department of Pediatrics, George Washington University, Washington, DC, USA.
OBJECTIVE: To compare treatment of ongoing seizures using intramuscular
(IM) midazolam versus intravenous (IV)diazepam.
DESIGN: Controlled clinical trial.
PATIENTS: Children with motor seizures of at least 10 minutes' duration.
MAIN OUTCOME MEASURES: Time to cessation of seizures.
RESULTS: Twenty-four patients were enrolled (13 midazolam, 11 diazepam).
Initial treatment with either midazolam or diazepam was successful in 22 of
the 24 patients. One patient in each group failed therapy and eventually
required endotracheal intubation and general anesthesia for convulsive
status epilepticus lasting more than one hour. Patients in the midazolam
group received medication sooner (3.3 +/- 2.0 vs 7.8 +/- 3.2 minutes, P =
0.001) and had more rapid cessation of their seizures (7.8 +/- 4.1 vs 11.2
+/- 3.6, P = 0.047) than patients randomized to receive diazepam.
CONCLUSIONS: IM midazolam is an effective anticonvulsant for children with
motor seizures. Compared to IV diazepam, IM midazolam results in more rapid
cessation of seizures because of more rapid administration. The IM route of
administration may be particularly useful in physicians' offices, in the
prehospital setting, and for children with difficult IV access.
Gershon Segal, MD
Johns Hopkins University School of Medicine
Division of Pediatric Emergency Medicine
600 North Wolfe Street / CMSC 144
Baltimore, MD 21287-3144
(410)955-6143 / Fax: (410)614-7339
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