A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children

OBJECTIVE:To compare treatment of ongoing seizures using intramuscular (IM) midazolam versus intravenous (IV) diazepam DESIGN:Controlled clinical trial PATIENTS:Children with motor seizures of at least 10 minutesʼ duration MAIN OUTCOME MEASURES:Time to cessation of seizures RESULTS:Twenty-four patients were enrolled (13 midazolam, 11 diazepam). Initial treatment with either midazolam or diazepam was successful in 22 of the 24 patients. One patient in each group failed therapy and eventually required endotracheal intubation and general anesthesia for convulsive status epilepticus lasting more than one hour. Patients in the midazolam group received medication sooner (3.3 ± 2.0 vs 7.8 ± 3.2 minutes, P=0.001) and had more rapid cessation of their seizures (7.8 ± 4.1 vs 11.2 ± 3.6, P=0.047) than patients randomized to receive diazepam CONCLUSIONS:IM midazolam is an effective anticonvulsant for children with motor seizures. Compared to IV diazepam, IM midazolam results in more rapid cessation of seizures because of more rapid administration. The IM route of administration may be particularly useful in physiciansʼ offices, in the prehospital setting, and for children with difficult IV access