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Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study
Open accessAbstract
OBJECTIVE: To compare the safety and efficacy of midazolam given intranasally with diazepam given intravenously in the treatment of children with prolonged febrile seizures. DESIGN: Prospective randomised study. SETTING: Paediatric emergency department in a general hospital. SUBJECTS: 47 children aged six months to five years with prolonged febrile seizure (at least 10 minutes) during a 12 month period. INTERVENTIONS: Intranasal midazolam (0.2 mg/kg) and intravenous diazepam (0.3 mg/kg). MAIN OUTCOME MEASURES: Time from arrival at hospital to starting treatment and cessation of seizures. RESULTS: Intranasal midazolam and intravenous diazepam were equally effective. Overall, 23 of 26 seizures were controlled with midazolam and 24 out of 26 with diazepam. The mean time from arrival at hospital to starting treatment was significantly shorter in the midazolam group (3.5 (SD 1.8) minutes, 95% confidence interval 3.3 to 3.7) than the diazepam group (5.5 (2.0), 5.3 to 5.7). The mean time to control of seizures was significantly sooner (6.1 (3.6), 6.3 to 6.7) in the midazolam group than the diazepam group (8.0 (0.5), 7. 9 to 8.3). No significant side effects were observed in either group. CONCLUSION: Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam, although midazolam was as safe and effective as diazepam. The overall time to cessation of seizures after arrival at hospital was faster with intranasal midazolam than with intravenous diazepam. The intranasal route can possibly be used not only in medical centres but in general practice and, with appropriate instructions, by families of children with recurrent febrile seizures at home.
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“studies have suggested that intranasal midazolam is safe and effective for acute seizure management in children (124, 127, 128, 135, 136).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [124]
In the citing paper
“Open-label studies have suggested that intranasal midazolam is safe and effective for acute seizure management in children (124, 127, 128, 135, 136).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [124]
In the citing paper
“with 88% of seizures (23 of 26) responding to initial treatment with midazolam and 92% (24 of 26) responding to diazepam (124).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [124]
In the citing paper
“In three controlled clinical trials, the efficacy of intranasal midazolam was similar to or better than that of i.v. or rectal diazepam (124, 127, 128).”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [124]
In the citing paper
“In a prospective, randomized, open-label study, intranasal midazolam was as safe and effective as i.v.diazepam was for managing febrile seizures”
From Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics (2008) · cites this paper as [124]
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Guidelines for the Evaluation and Management of Status Epilepticus
Brophy, G. M., BELL, R. D., Claassen, J., Alldredge, B. K., Bleck, T. P., Glauser, T. A., LaRoche, S. M., Riviello, J. J., Shutter, L., Sperling, M. R., et al. (2012) · Neurocritical Care · doi:10.1007/s12028-012-9695-z · Cited by 1,650
Glauser, T. A., Shinnar, S., Gloss, D. S., Alldredge, B. K., Arya, R., Bainbridge, J. L., Bare, M. A., Bleck, T. P., Dodson, W. E., Garrity, L. C., et al. (2016) · Epiliepsy currents/Epilepsy currents · doi:10.5698/1535-7597-16.1.48 · Cited by 1,316
Evaluation of intranasal delivery route of drug administration for brain targeting
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Benzodiazepines in epilepsy: Pharmacology and pharmacokinetics
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Metadata
- Authors
- Lahat, E.
- Affiliations
- Assaf Harofeh Medical Center (IL)
- Corresponding author
- Lahat, E.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-07-08
- Volume
- 321
- Issue
- 7253
- Pages
- 83-86
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC27427
- OpenAlex
- W2059085344
- Cited by
- 294
- References
- 46
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 13 · 2021: 11 · 2020: 15 · 2019: 9 · 2018: 8 · 2017: 14 · 2016: 12 · 2015: 25 · 2014: 21 · 2013: 13 · 2012: 11
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Epilepsy research and treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- febrile seizures, prolonged febrile seizures, intranasal midazolam, intravenous diazepam, benzodiazepines, seizure control, pediatric emergency care, time to treatment, children
- MeSH terms
- Administration, Intranasal, Anticonvulsants, Child, Child, Preschool, Seizures, Febrile, Diazepam, Female, Humans, Infant, Infusions, Intravenous, Male, Midazolam, Prospective Studies, Treatment Outcome
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