Impact of a protocol using intranasal midazolam for managing seizures

idazolam was first used in 1982 (O’Regan, Brown & Clarke, 1996). Unlike rectal diazepam (RD), which has a number of disadvantages including the need for privacy, intranasal midazolam (INM) can be easily administered in the community. Scheepers, Scheepers & Clough (1998) also claimed that fear of RD administration has been cited as a reason for truancy among older children with epilepsy. Additionally, they pointed out that the long half life of 20-40 hours may result in drowsiness which in itself may paradoxically lower the seizure threshold, leaving the patient more susceptible to further seizures.Nasal administration of midazolam results in rapid absorption from an area rich in blood supply, cerebrospinal fluid concentrations peaking 5-12 minutes after administration. INM does not have the disadvantage of being processed through the liver, unlike buccal administration, and has a mean elimination half life of two hours in healthy subjects.