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Buccal midazolam may be a useful alternative to rectal diazepam for treating acute seizures in refractory epilepsy

Design
Randomised (allocation concealed^*), unblinded,^* controlled trial with follow-up to end of seizure.

Setting
A residential centre for children and young people with severe epilepsy and other needs in Lingfield, Surrey, UK.

Patients
18 of 42 enrolled students with refractory epilepsy (mean age 15 y, 50% girls) who had previously received rectal diazepam for acute seizures and who had a seizure that lasted 3 minutes during the study period. Follow-up was complete.

Intervention
When a seizure occurred, the student was allocated to receive either midazolam, 2 ml (10 mg) in a 2 ml syringe given buccally (n=40 seizures in 14 patients), or diazepam, 10 mg given rectally (n=39 seizures in 14 patients).

Main outcome measures
Clinical response (seizure stopped within 10 min), time taken for nurse to give medication, time to clinical response, and incidence of adverse events.

Main results
In the midazolam group, 24 seizures were generalised tonic-clonic, 8 were complex partial, 6 were myoclonic, and 2 . . . [Full text of this article]

Samuel Wiebe, MD, MSc

University of Western Ontario London, Ontario, Canada