Efficacy of Midazolam Vs Diazepam in The Treatment of Status Epilepticus

Efficacy of Midazolam Vs Diazepam

Authors

  • Azal Khan Pediatric Unit, MTI Lady Reading Hospital, Peshawar, Pakistan
  • Salma Aziz Pakistan Air Force Base, Risalpur, Pakistan
  • Khowla Anis THQ Shakargarh, Lahore, Pakistan
  • Muhammad Qasim Khan Pediatric Unit, Bacha Khan Medical College, Mardan, Pakistan
  • Taimoor Jamil NCHD, Services Hospital, Lahore, Pakistan
  • Muhammad Salman Pediatric B Unit, MTI Lady Reading Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i06.842

Keywords:

Status Epilepticus, Midazolam, Diazepam, Efficacy

Abstract

Managing status epilepticus remains a formidable task in contemporary epilepsy care. This persistent and self-perpetuating epileptic activity presents with various manifestations with generalized convulsions being the prevailing form. Objective: To compare the efficacy of intravenous Midazolam with intravenous Diazepam in the treatment of status epilepticus. Methods: It was a Randomized controlled trial conducted at Pediatric Department, Lady Reading Hospital Peshawar. All new cases of SE were enrolled in study in OPD. Patients in group A were subjected to intravenous midazolam (0.2 mg/kg body weight infused in normal saline over 10 mins) and patients in group B were subjected to DZP (0.15mg/kg body weight infused in normal saline over 10 mins). All children were carefully monitored for the cessation of SE. Results: Out of the 120 cases included in the study, 72 (60.0%) were male patients, and 48 (40.0%) were female patients. The average age of the study participants was 3.67 ± 1.81 years. Among these 120 cases, 77 (64.2%) resided in rural areas, while 43 (35.8%) lived in urban areas. Efficacy was noted in 97 (80.8%) of our study cases, efficacy in group A was noted to be in 56 (93.3%) while in group B efficacy was noted to be in 41 (68.3%) (p = 0.001). Conclusions: Our study results support the use of Midazolam as it was found to be safe, effective and reliable as compared with Diazepam, as efficacy was significantly more common in Midazolam group.

References

Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus–Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015 Oct; 56(10): 1515-23. doi: 10.1111/epi.13121. DOI: https://doi.org/10.1111/epi.13121

Neligan A and Walker MC. Letter Re" Status epilepticus-related etiology, incidence and mortality: A meta-analysis" by Lv RJ et al., 2017. Epilepsy Research. 2017 Nov; 137: 121-2. doi: 10.1016/j.eplepsyres.2017.08.015. DOI: https://doi.org/10.1016/j.eplepsyres.2017.08.015

Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus—related hospitalizations and mortality: redefined in US practice over time. JAMA Neurology. 2015 Jun; 72(6): 650-5. doi: 10.1001/jamaneurol.2015.0188. DOI: https://doi.org/10.1001/jamaneurol.2015.0188

Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocritical Care. 2014 June; 20(3):476-83. doi: 10.1007/s12028-013-9935-x. DOI: https://doi.org/10.1007/s12028-013-9935-x

Sutter R, Dittrich T, Semmlack S, Rüegg S, Marsch S, Kaplan PW. Acute systemic complications of convulsive status epilepticus—a systematic review. Critical Care Medicine 2018 Jan; 46(1): 138-45. doi: 10.1097/CCM.0000000000002843. DOI: https://doi.org/10.1097/CCM.0000000000002843

Lai A, Outin HD, Jabot J, Mégarbane B, Gaudry S, Coudroy R, et al. Functional outcome of prolonged refractory status epilepticus. Critical Care. 2015 April; 19(1): 199. doi: 10.1186/s13054-015-0914-9. DOI: https://doi.org/10.1186/s13054-015-0914-9

Yasiry Z and Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine-resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure. 2014 Mar; 23(3): 167-74. doi: 10.1016/j.seizure.2013.12.007. DOI: https://doi.org/10.1016/j.seizure.2013.12.007

Rogalski R and Rogalski A. Benzodiazepine selection in the management of status epilepticus: a review. Advanced Emergency Nursing Journal. 2015 April; 37(2): 83-94. doi: 10.1097/TME.0000000000000064 DOI: https://doi.org/10.1097/TME.0000000000000064

Lawton B, Davis T, Goldstein H, Tagg A. An update in the initial management of paediatric status epilepticus. Current Opinion Pediatric. 2018 Jun; 30(3): 359-63. doi: 10.1097/MOP.0000000000000616. DOI: https://doi.org/10.1097/MOP.0000000000000616

Chamberlain JM, Okada P, Holsti M, Mahajan P, Brown KM, Vance C, et al. Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 2014 April; 311(16): 1652-60. doi: 10.1001/jama.2014.2625. DOI: https://doi.org/10.1001/jama.2014.2625

Brigo F, Bragazzi NL, Bacigaluppi S, Nardone R, Trinka E. Is intravenous lorazepam really more effective and safe than intravenous diazepam as first-line treatment for convulsive status epilepticus? a systematic review with meta-analysis of randomized controlled trials. Epilepsy and Behavior. 2016 Nov; 64: 29-36. doi: 10.1016/j.yebeh.2016.09.020. DOI: https://doi.org/10.1016/j.yebeh.2016.09.020

Fernandez A, Lantigua H, Lesch C, Shao B, Foreman B, Schmidt JM, et al. High-dose midazolam infusion for refractory status epilepticus. Neurology. 2014 Jan; 82(4): 359-65. doi: 10.1212/WNL.0000000000000054. DOI: https://doi.org/10.1212/WNL.0000000000000054

Welch RD, Nicholas K, Durkalski‐Mauldin VL, Lowenstein DH, Conwit R, Mahajan PV, et al. Neurological Emergencies Treatment Trials (NETT) Network Investigators. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia. 2015 Feb; 56(2): 254-62. doi: 10.1111/epi.12905. DOI: https://doi.org/10.1111/epi.12905

Koul RL, Aithala GR, Chacko A, Joshi R, Elbualy MS. Continuous midazolam infusion as treatment of status epilepticus. Archives of Disease in Childhood. 1997 May; 76(5): 445-8. doi: 10.1136/adc.76.5.445. DOI: https://doi.org/10.1136/adc.76.5.445

Chamberlain JM, Altieri MA, Futterman C, Young GM, Ochsenschlager DW, Waisman Y. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatric Emergency Care. 1997 April; 13(2): 92-4. doi: 10.1097/00006565-199704000-00002. DOI: https://doi.org/10.1097/00006565-199704000-00002

Portela JL, Garcia PC, Piva JP, Barcelos A, Bruno F, Branco R. Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial. Medicina Intensiva. 2015 April; 39(3): 160-6. doi: 10.1016/j.medin.2014.04.003. DOI: https://doi.org/10.1016/j.medin.2014.04.003

Ibrahim SH, Yezdan MA, Nizami SQ. Status Epilepticus in Children: a five-year Experience at Aga Khan University Hospital. Journal of Pakistan Medical Association. 2003 Dec; 53(12): 597-9.

Ahmed K, Jafr SK, Bhatti F, Rafique A, Haque A. Clinical profile and outcome of children admitted with status epileptics in PICU of a developing country. Pakistan Journal of Neurological Sciences. 2013; 8(2): 1-6.

Saeed T, Haq MZ, Kiani NM. Comparison of Buccal Midazolam with Rectal diazepam in Status Epilepticus in Terms of Recurrence of Seizures and Risk for Treatment Failure. Journal of Rawalpindi Medical College. 2015 Dec; 19(3): 197-9.

Burman RJ, Ackermann S, Shapson-Coe A, Ndondo A, Buys H, Wilmshurst JM. A Comparison of Parenteral Phenobarbital vs. Parenteral Phenytoin as Second-Line Management for Pediatric Convulsive Status Epilepticus in a Resource-Limited Setting. Frontier in Neurology. 2019 May; 10: 506. doi: 10.3389/fneur.2019.00506. DOI: https://doi.org/10.3389/fneur.2019.00506

Downloads

Published

2023-06-30
CITATION
DOI: 10.54393/pjhs.v4i06.842
Published: 2023-06-30

How to Cite

Khan, A., Aziz, S., Anis, K., Khan, M. Q. ., Jamil, T. ., & Salman, M. . (2023). Efficacy of Midazolam Vs Diazepam in The Treatment of Status Epilepticus: Efficacy of Midazolam Vs Diazepam. Pakistan Journal of Health Sciences, 4(06), 243–247. https://doi.org/10.54393/pjhs.v4i06.842

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)