USEFULNESS OF INTRAVENOUS MIDAZOLAM FOR STATUS EPILEPTICUS IN CHILDHOOD: A RETROSPECTIVE MULTI-CENTER STUDY IN JAPAN

Objectives: To evaluate the usefulness of midazolam (MDL) for the treatment of status epilepticus (SE).

Methods: A retrospective multi-center study was carried out with the participation of 16 institutions and their affiliated facilities nationwide in Japan from January 1991 to October 2002. The study subjects were 358 inpatients who received intravenous MDL therapy for SE.

Results: The mean subject age was 48.6±46.5 months. The underlying disorder was epilepsy in 195 cases, acute symptomatic diseases in 163 (encephalitis or encephalopathy in 88 cases). MDL was initially administered as an intravenous bolus injection at a dose of 0.25±0.21mg/kg, and subsequently as a continuous intravenous infusion at a rate of 0.26±0.25mg/kg/hr. The intravenous bolus injection was effective in 162 (56.6%) of the 286 cases. Continuous infusion eventually produced seizure suppression in 231 cases (64.5% of the total). The effectiveness of MDL was lower in patients in whom the MDL therapy was initiated more than 3 hours after seizure onset, and this tendency was particularly marked in the epilepsy group. Ten patients died during the treatment period, but none of these deaths was associated with MDL therapy. The incidence and type of adverse events were consistent with previous reports.

Conclusion: The present results indicate that MDL is a highly effective and very useful drug for the management of SE if used sufficiently early after seizure onset.