Intravenous midazolam for the treatment of refractory status epilepticus

Abstract

OBJECTIVE: To determine the usefulness of midazolam as a therapeutic agent for status epilepticus refractory to conventional treatment. DESIGN: Retrospective study. SETTING: ICUs of two university hospitals. PATIENTS: Seven patients with refractory status epilepticus who failed treatment with diazepam, lorazepam, and phenytoin, with or without phenobarbital. All patients received mechanical ventilation before receiving midazolam. INTERVENTIONS: Intravenous midazolam by bolus administration followed by infusion. MEASUREMENTS AND MAIN RESULTS: Midazolam terminated status epilepticus in all patients in less than 100 secs, as determined by clinical observation (three patients) or electroencephalographic monitoring (four patients). One patient developed mild hypotension. CONCLUSIONS: In this small study, midazolam appears to be an effective and safe alternative to high-dose barbiturate coma for the termination of status epilepticus when conventional agents have failed.