Home and hospital treatment of acute seizures in children with nasal midazolam

Jeannet, Pierre-Yves; Roulet, E.; Maeder-Ingvar, Malin; Gehri, Mario; Jutzi, Anne; Deonna, Thierry

doi:10.1016/s1090-3798(99)80016-6

Cited by 59 publications

(31 citation statements)

References 16 publications

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“…Various clinical reports have mentioned the successful use of midazolam for refractory status epilepticus without any adverse effects in infants and children. [20][21][22] We are of the opinion that the sedative and anticonvulsive properties of midazolam probably prevented the progression of a possible seizure attack and provided a comfortable treatment in the present case. The positioning of the patient in the supine position, close monitorization, administration of midazolam in anxiolytic dosages accompanied by inhalation sedation with N 2 O/O 2 and avoidance of hyperventilation probably contributed to the prevention of seizures.…”

Section: 11mentioning

confidence: 70%

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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Section: 11mentioning

confidence: 70%

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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“…Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…Rectal diazepam emerged as the primary treatment option for breakthrough seizures in the past. However rectal diazepam has slower onset of action than the intravenously delivered drug and is not as effective at controlling seizures (10).Other disadvantages include low social acceptability and high cost of the commercial preparation [10][11][12].Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

mentioning

confidence: 99%

Buccal Clonazepam versus Intravenous (I/V) Midazolam for Management of Acute Breakthrough Seizure –A Randomized Controlled Trial

Kumar¹

2016

JPNC

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Objectives: To compare efficacy and safety of buccal Clonazepam with I/V Midazolam in acute seizure therapy. Methods:A prospective, open label randomized controlled trial done on children with acute breakthrough seizure in known epileptics .200 breakthrough episodes were randomized to inject able midazolam (0.2mg/kg) or buccal clonazepam (0.01mg/kg) given on even days (IV Midazolam) and odd days (buccal Clonazepam).Results: Ninety two (92.0%) seizures were controlled IV Midazolam and eighty six (86.0%) in buccal Clonazepam group. No statistical significant (p=0.175) was observed .Recurrence after initial control was 8.0% in IV Midazolam and 9.0% in buccal Clonazepam group with no statistical significant (p=0.800) .Vital monitoring parameters maintained in both groups .16.0% revealed adverse reactions 10 min post drug administration, 4.0% in the midazolam, and 12.0% in clonazepam group (p value=0.119). Adverse effects required no intervention. Conclusions MonitoringPatients were monitored for vital parameters including heart rate, respiratory rate, blood pressure, saturation for ten minutes. The side effects of each drug were compared in different age groups with different semiology and etiology of seizures. We used Clonazepam (0.25/0.50/1.00mg) mouth dissolving dispersible clonazepam tablets. Statistical AnalysisData was recorded on a predesigned proforma and it was managed on a Microsoft Excel spread sheet. Statistical analysis was performed using software between the 2 groups: IV Midazolam and Buccal clonazepam. Categorical variables were summarized by frequency .Proportions were compared by chi-square test or Fisher's exact test (where expected frequency <5). Continuous variables having a normal distribution were summarized by mean and standard deviation; for others median was used .for continuous variables, student's 't' test , Mann Whitney U test or Wilcoxon signed rank sum test were applied as appropriate .P value of <0.05 was taken as significant . ResultsThe baseline characteristics of two drug groups with respect to age, sex, etiology of seizures, types of seizure, duration of seizure,EEG,neuroimaging were statistically comparable (

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“…No one trial has focused solely on comparing the adverse drug reactions of intranasal midazolam to rectal diazepam, but useful information can be extrapolated from several past studies. 1,8,12,16,17 A prospective, randomized trial by Holsti and colleagues 1 found no detectable difference in the number of adverse drug reactions among the intranasal midazolam and rectal diazepam groups. Occurrence of repeated seizure within 12 hours, need for ED services, and respiratory depression rates were similar.…”

Section: Safetymentioning

confidence: 99%

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

Humphries

Eiland

2013

The Journal of Pediatric Pharmacology and Therapeutics

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Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Although midazolam and diazepam are both members of the benzodiazepine class, the kinetic properties of these 2 anticonvulsants vary. This paper will review available data pertaining to the efficacy, safety, cost, and pharmacokinetics of intranasal midazolam versus rectal diazepam as treatment for acute seizures for children in the prehospital, home, and emergency department settings.

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Home and hospital treatment of acute seizures in children with nasal midazolam

Cited by 59 publications

References 16 publications

Reflex Epilepsy Triggered by Dental Treatment: A Case Report

Reflex Epilepsy Triggered by Dental Treatment: A Case Report

Buccal Clonazepam versus Intravenous (I/V) Midazolam for Management of Acute Breakthrough Seizure –A Randomized Controlled Trial

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

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