Controlling seizures in children: diazepam or midazolam? Systematic review

Introduction: Diazepam is commonly used to treat acute childhood seizures, but difficulty gaining intravenous access and variability of absorption after rectal administration can limit its efficacy. Midazolam is a water soluble benzodiazepine that has a rapid onset of action after intranasal or buccal administration and provides an alternative to diazepam in the control of acute childhood seizures. Methods: A literature search was performed to identify papers comparing the efficacy and tolerability of midazolam and diazepam in the management of childhood seizures. Results: Intranasal or buccal midazolam are at least as effective as rectal or intravenous diazepam in controlling acute childhood seizures. In all robust studies reporting a significant difference, time to gain seizure control was shorter in patients treated with midazolam than those treated with diazepam, predominantly due to shorter drug administration time. The incidence of seizure recurrence was lower in patients treated with midazolam than diazepam. Respiratory depression was uncommon in both groups. Conclusion: Intranasal or buccal midazolam provides a safe, effective and acceptable alternative to intravenous or rectal diazepam in the management of acute childhood seizures. (Hong Kong j.emerg.med. 2010; 17:196-204)