Low-dose buccal midazolam for aborting seizures in children

Twenty-eight children with tonic clonic seizures and with mean age of 4.6 years received buccal midazolam in a dose of 0.2 mg/kg for control of seizures. Thirteen children were known epilepsy and were on regular antiepileptic treatment, eight had febrile seizures, four had idiopathic first onset seizures, two had meningitis and one hypocalcemia. The seizures were controlled in 64% of patients with first dose of buccal midazolam and seven patients needed a second dose. These seven patients also received phenytoin/phenobarbitone infusion following the 2nd dose of buccal midazolam. The dose of buccal midazolam was not increased to more than 0.2 mg/kg in any of the patients. Low dose midazolam given by the buccal route is often sufficient to control seizures effectively.