Prastiya Indra Gunawan, Muhammad Riza Kurniawan, Darto Saharso.
The Efficacy and Safety of Intramuscular Midazolam Compared with Rectal Diazepam for Anticonvulsant in Children.
Pak Paed J Jan ;39(4):227-32.

Background: Seizure is the top 2 among the top 10 pediatric neurologic complaint in primary care according to pediatric survey data. Benzodiazepine are considered the drugs of choice for the treatment of seizures. Rectal diazepam is effective to terminate seizure but it has some disadvantages. The use of intravenous access is difficult, and requiring more time. Midazolam has the physical-chemical characteristics that facilitate rapid absorption following intramuscular injection. The objective of the research is to determine the effectiveness of intramuscular midazolam compared with rectal diazepam to terminate seizures in children. Methods: The children, 1 month till 18 years of age presented with acute seizures. Patients were classified into 2 groups with either received intramuscular midazolam or rectal diazepam to terminate seizures. The interval time of drug administration to cease seizure was compared. Log rank analysis was used for statistical analysis. Side effect of both drugs were evaluated. Results: There were 66 patients, 33 in each groups enrolled the study. The median interval time for seizures cessation with intramuscular midazolam was 45 seconds, otherwise in rectal diazepam group was 180 seconds. There was statistically significant difference interval time between two groups (p<0.01). Five patients had time cessation of seizure more than 5 minutes. None of the both groups had any significant side effects statistically. Conclusion: Intramuscular midazolam is effective to terminate seizures in children. It can be used as an alternative treatment for acute seizure in patients with intravenous or rectal route difficulties.

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