Buccal Midazolam versus Intravenous Diazepam in Prolonged Seizures in Children

Background: Seizure episode is a common neurological emergency carrying high morbidity and mortality. It has been shown that prompt treatment of episodes of seizure at home results in need of fewer drugs at hospital and quicker control of the seizure/seizure episodes. Buccal midazolam can be recommended as an alternative to intravenous (I/V) diazepam (DZ) as first choice in situations of difficulty in getting I/V access. Materials and Methods: Design: Prospective randomized controlled study. Setting: Conducted in the Department of Pediatrics, Government Medical College and Hospital, Amritsar, during the period from January 2009 to December 2009. Total 100 (59 boys, 41 girls) patients were enrolled in the study. In the study group (BMDZ), patients received buccal midazolam (0.3 mg/kg/dose) and in control group (IVDZ), patient received I/V DZ (0.2 mg/kg/dose). Results: In BMDZ group, 48 (96%) cases of seizures were aborted by giving buccal midazolam and in IVDZ group also an equal number, i.e., 48 (96%) cases of seizures were aborted by giving DZ intravenously (P > 0.05). The mean time needed for cessation of seizures in BMDZ group was 96.0 +/- 144.69 s (1.60 min) with the lowest time being 30 s and the highest being 790 s, and it was 83.40 +/- 124.27 s (1.39 min) in IVDZ group with the lowest being 30 s and the highest being 685 s. The difference in time taken to control seizures between two groups was statistically insignificant (P = 0.641). No significant side effects were seen in either group. Conclusions: It is concluded from the above study that buccal midazolam is equally effective and more convenient as compared to I/V DZ in prolonged seizures while both are comparable in safety.