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Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Acute Seizures in Pediatric
Patients With Epilepsy
Holsti M, Dudley N, Schunk J, et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010;164(8):747-753.
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Introduction
• Rectal diazepam (RD) is a rescue medication frequently prescribed for the home treatment of seizures.
• Intranasal midazolam has also been used as a home rescue medication for the treatment of seizures.
• The Mucosal Atomization Device has been developed for nasal drug delivery.
• We sought to compare the effectiveness of the Intranasal Midazolam Mucosal Atomization Device (IN-MMAD) with that of RD for the home treatment of seizures in children with epilepsy.
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Methods
• Patients who visited a pediatric neurology clinic were identified and enrolled from July 2006 through September 2008.
• Prospective randomized trial; not blinded.
• Inclusion criteria:• Aged <18 years, with diagnosis of epilepsy.• Pediatric neurologist to send patient home with rescue medication for
his or her next seizure.
• Exclusion criteria:• Patients who receive home treatment with benzodiazepines other than
diazepam or midazolam (ie, lorazepam).
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Methods
• Primary outcome measure: seizure duration after administration of study medication.
• Analyzed by Wilcoxon rank sum test.
• Limitations:• Variability in seizure start times and stop times.• Potential selection bias.
- Some caretakers decided not to participate when told they could not choose the study medication.
• Experience.- Some caretakers had more experience treating seizures at home.
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Comment
• There was no difference between IN-MMAD and RD in terminating pediatric seizures at home and no differences in complications.
• Ease of administration and overall satisfaction were higher in the IN-MMAD
group compared with the RD group.
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CommentFuture Directions
• IN-MMAD may be a good alternative for older pediatric patients with seizures.
• Patients/caretakers may not want not to receive/give medications rectally.
• The intranasal volume may limit the maximum amount given to an older patient.
• IN-MMAD may be a less expensive alternative for the treatment of seizures.• Cost analysis must be done.
• IN-MMAD may be difficult to give to young children with congestion unless suctioning is available.
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Contact Information
• If you have questions, please contact the corresponding author:
Maija Holsti, MD, MPH ([email protected]).
Funding/Support
• This study was supported by Primary Children’s Medical Center Foundation, Salt Lake City, Utah.
