Comparative non-randomized study with midazolam versus thiopental in children with refractory status epilepticus

We evaluated the use of midazolam versus thiopental in 50 children with refractory status epilepticus (RSE), admitted in a pediatric intensive care unit. The study consisted of two groups of patients: Group A - Midazolam, a prospective study, and Group B - Thiopental, a historical group. These patients already had previous medication with benzodiazepin and diphenylhydantoin and other drugs. When there was no effective control of the seizures, the patients of Group A received midazolam of 200 mu g/kg intravenous in bolus, being followed by continuous intravenous infusion at the rate 0.25-15 mu/kg/min. Group B received thiopental 1 mg/kg intravenous in bolus followed by continous intravenous infusion at the rate of 10-120 mu g/kg/min. In relation to the time of seizure control and effectiveness, there was no statistical significance for the two groups. The Midazolam Group had significantly less complications during the treatment: less cyanosis (p = 0.00006), and they did not need respiratory support (p < 0.00001). When the therapy with midazolam was ceased, 12.5% of the patients from this group showed psychological disorders such as mental confusion, aggressive behavior, restlessness, hallucinations and agitation.