Comparison of Intranasal Midazolam with Rectal Diazepam for Treatment of Acute Seizures in Children

Seizure is the most common neurological medical emergency. Early treatment before admission to hospital is best achieved with an effective and safely administered medication. The aim of this stuy was to compare the efficacy, time to control of seizure and side effects of rectal diazepam with intranasal midazolam in the treatment of children with acute seizure. One hundred and fitten patients were enrolled at the medicla centre. Their ages were between two months to 14 years. Continuous seizures of more than 5 minutes duration were randomly treated with rectal diazepam or intranasal midazolam. These preparations were made extramputaously from ampoule fomulations forcedly for non-existence of rectal diazepam and intranasal midazolam products at time of the study. If the seizure did not stop within ten minutes, additional medication chosen by the pediatric residents was administered. We monitored and checked oxygen saturation, blood pressure, pulse rate, respiratory rate and body temperature for 60 minutes after treatment. The main outcome measures were efficacy, time from drug administration to stoppage of seizure and incidence of adverse cardio respiratory events. Rectal diazepam was used to treat 56 seizure episodes and intranasal midazolam in 59 ones. Rectal diazepam stopped 32 (57%) of 56 episodes. Intranasal midazolam stopped 49 (83%) of 59 episodes (p<0.001). The mean time to control of seizures was significantly faster in midazolam group (2.9  1.89 minutes, 95% confidence interval: 2.3 to 3.4 minutes) than the diazepam group (4.6  2.34 minutes, 95% confidence interval: 3.8 to 5.5 minutes). No significant difference in side effects was observed in either group. In diazepam group, a 4 months old infant with opioid poisoning died and in midazolam group, a 13-year old adolescent with cerebral palsy developed transient apnea. We concluded that intranasal midazolam is more effective than rectal diazepam in the treatment of acute seizures. Seizures were controlled more quickly with intranasal midazolam than rectal diazepam. Nasally administration is more socially acceptable and convenient. With appropriate instructions, families may be able to administer it to their children with recurrent seizures outside hospital.