Treatment of Refractory Generalized Status Epilepticus With Continuous Infusion of Midazolam

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Objective:  To  determine the efficacy and safety of
midazolam given as a continuous infusion in the treat-ment of refractory generalized status epilepticus
(RGSE).
Method: Prospective, open study. Eleven patients with
RGSE, who received intravenous doses of 0.3 mg/kg
of diazepam (three times at 5 min intervals), 20 mg/kg
of phenytoin, and 20 mg/kg of phenobarbital that failed
to bring the episode under control were administered
a bolus of midazolam (200 mg/kg iv) followed by a con-tinuous infusion at 1 mg/kg/min. The dose was in-creased every 15 min until the episode of seizure was
brought under control. Time to control seizures, infu-sion rate, and side-effects were monitored.
Results:  The mean age of the patients was 22.8 yrs
(range 16 yrs to 73 yrs; 5 females and 6 males). In ten
of the patients, seizures were completely controlled in
a mean time of 2.1 hrs (range 0.4 hrs to 4.5 hrs), with
an infusion rate of 8.4 mg/kg/min (range 3 to 12). In
one patient seizures did not stop. None of the patients
had clinically important changes in blood pressure,
heart rate, oxygen saturation  or respiratory status at-tributable to the use of midazolam. The mean time to
full consciousness for patients after stopping the in-fusion was 1.6 hrs (range 2 to 8.5).
Conclusion: Midazolam is an effective and safe drug
to control RGSE and may represent a substantial im-provement over current therapeutic approaches such
as pentobarbital anesthesia.
Key words: Midazolam, anticonvulsants, status epilepticus,
neurologic emergencies.

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