Continuous rate infusion of midazolam as emergent treatment for seizures in dogs

Background Midazolam delivered by continuous rate infusion (CRI) might be effective in dogs with cluster seizures (CS) or status epilepticus (SE). Objective To describe the use and safety of midazolam CRI in dogs with CS or SE. Animals One-hundred six client-owned dogs presenting to a veterinary teaching hospital with CS or SE. Methods Retrospective review of medical records for dogs with CS or SE treated with a midazolam CRI. Results Seventy-nine dogs presented with CS and 27 dogs had SE. Seizure control was achieved in 82/106 dogs (77.4%) receiving a midazolam CRI. The median dose associated with seizure control was 0.3 mg/kg/h (range, 0.1-2.5 mg/kg/h). The median duration of CRI was 25 hours (range, 2-96 hours). Seizures were controlled in 34/40 dogs (85%) with idiopathic epilepsy, 32/43 dogs (74%) with structural epilepsy, 12/16 dogs (75%) with unknown epilepsy, and 4/7 dogs (57%) with reactive seizures (P = .20). Seizure control was achieved in 81% of dogs with CS and 67% in dogs with SE (P = .18). Dogs with idiopathic/unknown epilepsy were more likely to survive than those with structural epilepsy (87% vs 63%, P = .009). Adverse effects were reported in 24 dogs (22.6%) and were mild in all cases. Conclusions and clinical importance Midazolam CRI is apparently safe and might be an effective treatment in dogs with CS or SE.