Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: A randomized clinical trial☆

Abstract Aim To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children. Design Randomized clinical trial. Setting Pediatric emergency department. Patients: Children aged 2 months to 14 years admitted to the study facility with seizures. Intervention Patients were randomized to receive DZP-IV or MDZ-IM. Main measurements Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5 min of drug administration. Results Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5 min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4 min; p p  = 0.006, respectively). In two children per group (12.5%), seizures continued after 10 min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events ( p  = 0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group. Conclusion Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.