Treatment of Refractory Generalized Status Epilepticus With Continuous Infusion of Midazolam

Abstract

Objective: To determine the efficacy and safety of midazolam given as a continuous infusion in the treat-ment of refractory generalized status epilepticus (RGSE). Method: Prospective, open study. Eleven patients with RGSE, who received intravenous doses of 0.3 mg/kg of diazepam (three times at 5 min intervals), 20 mg/kg of phenytoin, and 20 mg/kg of phenobarbital that failed to bring the episode under control were administered a bolus of midazolam (200 mg/kg iv) followed by a con-tinuous infusion at 1 mg/kg/min. The dose was in-creased every 15 min until the episode of seizure was brought under control. Time to control seizures, infu-sion rate, and side-effects were monitored. Results: The mean age of the patients was 22.8 yrs (range 16 yrs to 73 yrs; 5 females and 6 males). In ten of the patients, seizures were completely controlled in a mean time of 2.1 hrs (range 0.4 hrs to 4.5 hrs), with an infusion rate of 8.4 mg/kg/min (range 3 to 12). In one patient seizures did not stop. None of the patients had clinically important changes in blood pressure, heart rate, oxygen saturation or respiratory status at-tributable to the use of midazolam. The mean time to full consciousness for patients after stopping the in-fusion was 1.6 hrs (range 2 to 8.5). Conclusion: Midazolam is an effective and safe drug to control RGSE and may represent a substantial im-provement over current therapeutic approaches such as pentobarbital anesthesia. Key words: Midazolam, anticonvulsants, status epilepticus, neurologic emergencies.