Midazolam for treatment of refractory neonatal seizures: a case report

Gherpelli, José Luiz Dias; Luccas, Francisco José C.; Roitman, Israel; Troster, Eduardo Juan

doi:10.1590/s0004-282x1994000200019

Cited by 12 publications

(3 citation statements)

References 5 publications

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“…1,2 For nonresponsive cases, continuous intravenous drip of either midazolam or lidocaine has been suggested for seizure control. [3][4][5][6][7] In its last update in 2004,…”

mentioning

confidence: 99%

Comparison of Continuous Drip of Midazolam or Lidocaine in the Treatment of Intractable Neonatal Seizures

2007

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Seizures constitute the most common neurological symptom in the neonatal period. Treatment usually involves the administration of intravenous benzodiazepines followed by either phenobarbital or phenytoin. For nonresponsive cases, continuous intravenous drip of either midazolam or lidocaine has been suggested for seizure control. Some reports suggest that seizures themselves may have a deleterious effect on long-term neurological outcome. Therefore, there is a need to find treatment regimens with better efficacy to provide maximum seizure control. The authors compared the effectiveness of lidocaine and midazolam in the treatment of intractable seizures in newborn infants born at or after 36 weeks of gestation who suffered from hypoxic-ischemic encephalopathy and who had their cerebral activity monitored. Thirty infants were included in the study: 22 received lidocaine, and 8 received midazolam. Seventeen (77%) infants had a good or partial response to lidocaine, and 4 (50%) had a partial response to midazolam. Of 20 infants diagnosed with hypoxic-ischemic encephalopathy grade 2, 18 (90%) responded to second-line treatment (14 [93%] of 15 to lidocaine and 4 [80%] of 5 to midazolam). Among 10 infants with hypoxic-ischemic encephalopathy grade 3, only 3 (30%) responded to second-line treatment (all 3 to lidocaine, none to midazolam). The findings suggest that lidocaine may be more effective than midazolam in reducing or controlling refractory neonatal seizures. The lower response rate to midazolam was more evident in infants with severe hypoxic-ischemic encephalopathy (grade 3).

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“…1,2 For nonresponsive cases, continuous intravenous drip of either midazolam or lidocaine has been suggested for seizure control. [3][4][5][6][7] In its last update in 2004,…”

mentioning

confidence: 99%

Comparison of Continuous Drip of Midazolam or Lidocaine in the Treatment of Intractable Neonatal Seizures

2007

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“…The effectiveness of i.v. midazolam in rapidly terminating episodes of SE refractory to other drug regimens was also demonstrated by Parent and Lowenstein 28 in three adults and one child, by Lemerle et al 29 in four children, and by Gherpelli et al 30 in a pre‐term newborn infant. In all cases seizure activity was brought under control within minutes of the bolus injection, and no significant respiratory or hacmodynamic adverse events were noted, even in the presence of considerable pre‐existing instabilities.…”

Section: Clinical Experience With Midazolam In Sementioning

confidence: 56%

Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Hanley

Pozo²

2000

Int J Clinical Practice

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SUMMARYStatus epilepticus (SE) is a potentially life‐threatening condition that requires prompt and aggressive treatment. Prolonged status seizures are associated with significant physiological sequelae and neurological deficits. Although systemic events such as hyperthermia and anoxia contribute to neuronal damage, SE in and of itself can induce cell death. In general, the sooner it is brought under control, the more favourable is the prognosis. Benzodiazepines, as a group, are the most frequently used anticonvulsants in the management of status seizures. Midazolam, a water‐soluble benzodiazepine, is a potent anticonvulsant that offers many advantages over typical benzodiazepines. Because of its stability in aqueous media, midazolam dissolves in common diluents such as normal saline or dextrose water. Consequently, midazolam both intravenously (i.v.) and intramuscularly (i.m.) is well tolerated locally and is associated with less venoirritation than benzodiazepines or antiepileptics that require organic solvents. The water solubility of midazolam also allows rapid and reliable absorption of the drug from the i.m. injection site. Because it is rapidly metabolised and its metabolites are pharmacologically inactive, midazolam has a short duration of action. Most patients regain full conscious state and can be evaluated soon after the cessation of treatment. Midazolam by continuous i.v. infusion and by the i.m. route has been successfully used in the treatment of SE. Although some respiratory and haemodynamic side‐effects have been associated with midazolam, no clinically significant side‐effects were observed with its use for the indication of SE. It is suggested that midazolam is a safe and rapidly effective treatment option in the management of SE in the critical care setting. (Int J Clin Pract 2000; 54(10): 30‐35)

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“…The antiepileptic effects of midazolam have been demonstrated in various animal and human studies. [17][18][19] Midazolam has a significant anticonvulsant property and is an effective treatment option in the management of status epilepticus. Various clinical reports have mentioned the successful use of midazolam for refractory status epilepticus without any adverse effects in infants and children.…”

Section: Discussionmentioning

confidence: 99%

Reflex Epilepsy Triggered by Dental Treatment: A Case Report

Kiliniç¹,

Işık²,

Ergüven³

et al. 2015

Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi

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Loss of consciousness is one of the most common medical emergencies during dental interventions. Syncope, transient ischemic attacks, epileptic seizures and nonepileptic psychogenic events can induce loss of consciousness. Reflex epilepsy is characterized by seizures accompanied by loss of consciousness that are triggered in response to a specific external or internal stimulus. Our aim was to report of a reflex epilepsy case triggered by dental treatment. In this paper, a 22-year-old ASA I male patient developing loss of consciousness with generalised tonic-clonic seizures, severe bradycardia and asystole during dental treatment is presented. He was diagnosed with reflex epilepsy. The reflex epilepsy was thought to have been triggered by hyperventilation resulting from dental anxiety and fear. Special consideration must be given to the differential diagnosis for conditions leading to loss of consciousness. Reflex epilepsy should be considered in cases during which loss of consciousness accompanied by/followed by convulsive seizures has occurred while the patient was exposed to specific external and internal stimulus.

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Midazolam for treatment of refractory neonatal seizures: a case report

Cited by 12 publications

References 5 publications

Comparison of Continuous Drip of Midazolam or Lidocaine in the Treatment of Intractable Neonatal Seizures

Comparison of Continuous Drip of Midazolam or Lidocaine in the Treatment of Intractable Neonatal Seizures

Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Reflex Epilepsy Triggered by Dental Treatment: A Case Report

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