Midazolam efficacy and side effects in generalized and partial refractory status epilepticus in children

Midazolam is a significant and effective drug for control of a life-threatening condition, generalized and partial refractory convulsive status epilepticus. The goal of this study was evaluation of midazolam efficacy for management of this serious disease and its two side effects, hypotension and respiratory failure. Our study was done using a quasi experimental method; 22 children with generalized refractory convulsive status epilepticus and 13 with partial refractory convulsive status epilepticus were enrolled for the study. All patients received 0.2mg/kg/dose as a bolus intravenous midazolam followed by 1-6 mcg/kg/min continuous intravenous midazolam. Following this, termination of seizures as well as hypotension and respiratory failure were evaluated. midazolam ceased stop convulsions in 81.81% [18] patients with generalized seizures, and in 76.92% [10] patients with partial seizures, showing no significant difference between these two types of seizures [p=0.52]. Hypotension was induced in 18.18% [4] patients with generalized seizures and in 30.70% [4] patients with partial seizures, again difference not significant [p=0.14]. There was respiratory failure in 21.73% [5] patients with generalized seizure and in 7.69[1] patients with partial seizure, difference not significant [p=0.09]. There was no significant difference in efficacy and creation of hypotension and respiratory failure after continuous intravenous infusion of midazolam between generalized and partial refractory convulsive status epilepticus

lumbar puncture always necessary in the febrile child with convulsion?

Febrile convulsion is the most common benign convulsive disorder in children. Meningitis is one of the most important causes of fever and convulsions, diagnosed by lumbar puncture [LP], a painful and invasive procedure much debated regarding its necessity. This study evaluates the frequency of abnormal LP findings in a group of patients, to determine whether or not unnecessary LP can be prevented without missing patients with serious problems such as meningitis. The study was a descriptive, cross sectional study, conducted on 200 children suffering from fever and convulsions. Medical files of patients were taken from the hospital records and relevant data were collected to complete the appropriate forms. Of 200 patients included in the study, 116 [58%] children were male, and 84 [42%] were female. 47 cases [23.5%] underwent LP, of whom just one [0.5%] had abnormal LP and meningitis. Regarding Considering the low prevalence of meningitis in children with convulsion and fever, we conclude that by means of precise clinical examination and monitoring, it is possible to prevent unnecessary LP in these patients