COMPARISON OF BUCCAL AND INTRAVENOUS MIDAZOLAM FOR THE TREATMENT OF ACUTE SEIZURES IN CHILDREN
DOI:
https://doi.org/10.69656/pjp.v21i3.1832Keywords:
Acute Seizures, Children, Buccal, Midazolam, Intravenous, DiazepamAbstract
Background: Convulsive disorders often present as urgent neurological conditions requiring prompt intervention like IV midazolam. However, establishing an IV line especially in the ER can delay treatment institution. Therefore, rectal, buccal and intramuscular routes for administration are considered in such cases. Objective of this study was to compare the mean time for control of acute seizures by using buccal and intravenous midazolam in children. Method: This was a quasi experimental study carried over 6 months in the Paediatric Accident and Emergency Department, PAF Hospital, Mushaf, Sargodha. The study included a total of 60 children in actively fitting state. The subjects were divided into 2 groups of 30 in each, Group A having buccal midazolam and Group B having IV midazolam for control of seizure episode. Repeat dose was given after 5 minutes if seizures were not controlled. Time required to control seizures was noted for each patient. Results: Patients included in study had a mean age of 3.93±3.05 years, with 28 (46.6%) males and 32 (53.33%) female patients. Forty-seven (78.33%) had generalized seizures and 13 (21.67%) had partial seizures. Mean time for control of seizures was 198.33±133.19 seconds in Group A and 169.73±115.22 seconds in Group B. The difference was statistically insignificant with p=0.377. Conclusion: Buccal midazolam is an effective method for controlling acute seizures in children. It can be used as first line therapy instead of intravenous midazolam in pre-hospital and emergency settings.
Pak J Physiol 2025;21(3):18–21, DOI: https://doi.org/10.69656/pjp.v21i3.1832
Downloads
References
Mitchell C, Chatterton Dickson L, Ramsay A, Mesalles-Naranjo O, Leonard P, Brand C, et al. Epidemiology and outcome of status epilepticus in children: a Scottish population cohort study. Dev Med Child Neurol 2021;63:1075–84.
Vasquez A, Gainza-Lein M, Sanchez Fernandez I, Abend NS, Anderson A, Brenton JN, et al. Pediatric Status Epilepticus Research Group (pSERG). Hospital emergency treatment of convulsive status epilepticus: comparison of pathways from ten pediatric research centers. Pediatr Neurol 2018;86:33–41.
Trau SP, Sterrett EC, Feinstein L, Tran L, Gallentine WB, Tchapyjnikov D. Institutional pediatric convulsive status epilepticus protocol decreases time to first and second line anti-seizure medication administration. Seizure 2020;81:263–8. Doi:10.1016/j.seizure.2020.08.011
McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev 2018;1(1):CD001905.
Singh A, Stredny CM, Loddenkemper T. Pharmacotherapy for paediatric convulsisve status epilepticus. CNS Drugs. 2020;34:47–63.
European Medicines Agency 2022. EMA recommends authorization of Nasolam (midazolam nasal spray) in the EU 28/01/2022; 2022. Available from: https://www.ema.europa.eu/ en/documents/referral/nasolam-article-294-referral-ema-recommends-authorisation-nasolam-midazolam-nasal-spray-eu_en.pdf. [Accessed: 20 Apr 2022]
Neligan A, Rajakulendran R, Walker MC. Advances in the management of generalized convulsive status epilepticus: what have we learned? Brain 2021;144:1336–41.
NICE Guideline (NG217). Epilepsies in children, young people and adults; 2022. Available from: https://www.nice.org.uk/guidance/ng217/chapter/5-Treating-epileptic-seizures-in-children-young-people-and-adults#focall-seziures-with-or-without-evolution-to-bilateral-tonic-clonic-seizures. [Accessed: 24 Jun 2022].
Sathe AG, Underwood E, Coles LD, Elm JJ, Silbergleit R, Chamberlain JM, et al. Patterns of benzodiazepine underdosing in the established status epilepticus treatment trial. Epilepsia 2021;62:795–806.
Keene JC, Woods B, Wainwright M, King M, Morgan LA. Optimized benzodiazepine treatment of pediatric status epilepticus through a standardized emergency medical services resuscitation too. Pediatr Neurol 2022;126:50–5.
Hasan SU, Pervez A, Bhatty S, Shamim S, Naeem A, Naseeb MW. Termination of seizures in the pediatric age group: best benzodiazepine and route of administration- a network meta-analysis. Eur J Neurosci 2022;56(3):4234–5.
Kienitz R, Kay L, Beuchat I, Gelhard S, von Brauchitsch S, Mann C, et al. Benzodiazepines in the management of seizures and status epilepticus: a review of routes of delivery, pharmacokinetics, efficacy, and tolerability. CNS Drugs 2022;36(9):951–75.
Gathwala G, Goel M, Singh J, Mittal K. Intravenous diazepam, midazolam and lorazepam in acute seizure control. Indian J Pediatr 2012;79(3):327–32.
Khandelwal R, Khandelwal LM, Singh K. Buccal midazolam versus intravenous diazepam in prolonged seizures in children. Int J Sci Stud 2015;3(4):58–62.
Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999;40(1):120–2.
Talukdar B, Chakrabarty B. Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsions in children: a randomized controlled trial. Brain Dev 2009;31(10):744–9.
Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomized study. BMJ 2017;321(1):83–6.
Brigo F, Nardone R, Tezzon F, Trinka E. Nonintravenous midazolam versus intravenous or rectal diazepam for the treatment of early status epilepticus: A systematic review with meta-analysis. Epilepsy Behav 2015;49:325–6.
Mohammed MZ, Elagouza I, El Gaafary M, El-Garhy R, El-Rashidy O. Intranasal versus buccal versus intramuscular midazolam for the home and emergency treatment of acute seizures in pediatric patients: A randomized controlled trial. Pediatr Neurol 2024;158:135–43.
El-Rashidy QF, Elagouza IA, El Gaafary MM, Mohammed MZR, Rashad RAM El-Garhy. Intranasal vs buccal vs intramuscular midazolam for the home and emergency treatment of acute seizures in pediatric Egyptian patients. Q J Med 2024;117(Suppl 1):1216,hcae070.501.
McLntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomized controlled trial. Lancet 2005;366(9481):205–10.
Mpimbaza A, Ndeezi G, Staedke S, Rosenthal PJ, Byarugaba J. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics 2018;121(1):e58–64.
Alansari K, Barkat M, Mohamed AH, Al Jawala SA, Othman SA. Intramuscular versus buccal midazolam for pediatric seizures: a randomized double-blinded trial. Pediatr Neurol 2020;109:28–34.
Riva A, Iapadre G, Grasso EA, Balagura G, Striano P, Verrotti A. Intramuscular midazolam for treatment of status epilepticus: a review of pharmacology and clinical use. Expert Opin Pharmacother 2021;22(1):37–44.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Abeer Asif, Hina Batool Siddiqui, Madeeha Ikram, Madiha Noor, Maryam Shehzadi, Saba Mushtaq
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The author(s) retain the copyrights and allow their publication in Pakistan Journal of Physiology, Pak J Physiol, PJP to be FREE for research and academic purposes. It can be downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.
