A comparison of buccal midazolam and intravenous diazepam for the acute treatment of seizures in children

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Objective: The purpose of the present study is to compare efficacy and safety of buccal midazolam with intravenous diazepam in control of seizures in Iranian children. Methods: This is a randomized clinical trial. 92 patients with acute seizures, ranging from 6 months to 14 years were randomly assigned to receive either buccal midazolam (32 cases) or intravenous diazepam (60 cases) at the emergency department of a children's hospital. The primary outcome of this study was cessation of visible seizure activity within 5 minutes from administration of the first dosage. The second dosage was used in case the seizure remained uncontrolled 5 minutes after the first one. Findings: In the midazolam group, 22 (68.8%) patients were relieved from seizures in 10 minutes. Meanwhile, diazepam controlled the episodes of 42 (70%) patients within 10 minutes. The difference was, however, not statistically significant (P=0.9). The mean time required to control the convulsive episodes after administration of medications was not statistically significant (P=0.09). No significant side effects were observed in either group. Nevertheless, the risk of respiratory failure in intravenous diazepam is greater than in buccal midazolam. Conclusion: Buccal midazolam is as effective as and safer than intravenous diazepam in control of seizures. © 2012 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, All rights reserved.




Tonekaboni, S. H., Shamsabadi, F. M., Anvari, S. S., Mazrooei, A., & Ghofrani, M. (2012). A comparison of buccal midazolam and intravenous diazepam for the acute treatment of seizures in children. Iranian Journal of Pediatrics, 22(3), 303–308. https://doi.org/10.1016/j.ejpn.2017.04.790

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