Intravenous midazolam for the treatment of refractory status epilepticus

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Abstract

Objective

To determine the usefulness of midazolam as a therapeutic agent for status epilepticus refractory to conventional treatment.

Design

Retrospective study.

Setting

ICUs of two university hospitals.

Patients

Seven patients with refractory status epilepticus who failed treatment with diazepam, lorazepam, and phenytoin, with or without phenobarbital. All patients received mechanical ventilation before receiving midazolam.

Interventions

Intravenous midazolam by bolus administration followed by infusion.

Measurements and Main Results

Midazolam terminated status epilepticus in all patients in >100 sees, as determined by clinical observation (three patients) or electroencephalographic monitoring (four patients). One patient developed mild hypotension.

Conclusions

In this small study, midazolam appears to be an effective and safe alternative to high-dose barbiturate coma for the termination of status epilepticus when conventional agents have failed.

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