Intramuscular marginally better than buccal midazolam for paediatric seizure

Intramuscular midazolam appears to be better than buccal administrations for first-line treatment of paediatric seizures, a recent study has found.

Researchers enrolled 150 children with active seizures. Half of the participants received midazolam intramuscularly (mean age, 49±46 months), while the other half were given buccal midazolam (mean age, 45±37 months). The primary efficacy outcome was the proportion of patients with seizure cessation within 5 minutes of drug administration.

Thirty-two children saw cessation of seizure within 5 minutes of buccal midazolam administration, yielding a rate of 46 percent. In comparison 41 patients in the intramuscular arm achieved the efficacy endpoint, with a rate of 61 percent. The absolute difference was of borderline significance (15.5 percent; p=0.07).

Moreover, the average time from medication administration to seizure cessation was marginally shorter in the intramuscular midazolam group (15.9±28.7 vs 17.8±27.5 minutes; p=0.69). Cox regression analysis showed that the duration of seizures after intramuscular vs buccal midazolam was 13 percent shorter, though significance was not achieved (p=0.49).

In terms of safety, one patient in the intramuscular arm developed respiratory depression and hypotension within 3 minutes of medication administration. Patient recovered fully with intervention and within 15 minutes after drug administration. Such an event was not observed in the buccal midazolam group.

“We conclude that the efficacy and safety of intramuscular midazolam as first-line treatment for paediatric seizures compares favourably to buccal midazolam,” researchers said.