A Prospective Study of Intranasal Midazolam for Children with Acute Seizures

Objective: To evaluate the use and safety of intranasal midazolam when used as first-line treatment for children with acute seizures. Study design: Prospective study of 20 children over the age of six months presenting with an acute seizure to the emergency department of a 70-bed children’s hospital in the UK. All children were treated with intranasal midazolam in a dose of 200 micrograms/kg. Efficacy and toxicity were assessed. Results: Midazolam controlled the seizure within 15 minutes in 10 patients (50%). A further five patients (25%) showed a partial response. Five children showed no response to midazolam. No adverse reactions were seen. Conclusion: This efficacy rate is lower than that shown in other studies. All studies to date have been small. It is suggested that larger, controlled studies are required to establish the place of midazolam, and alternative routes of administration, such as the intranasal route, in the treatment of children with acute seizures.