A Comparison of Midazolam and Thiopental Sodium in the Management of Refractory Status Epilepticus

ABSTRACT

BACKGROUND: Refractory status epilepticus (RSE) requires urgent and effective treatment. Recently, midazolam was suggested as a useful drug in controlling RSE. In order to evaluate the effectiveness and adverse effects of midazolam, we compared midazolam with thiopental sodium. METHODS: Fourteen consecutive RSE in 13 patients from January 1998 to August 1999 were treated. Two RSE were happened in one patient. When the SE was refractory as a result of standard treatment, midazolam and thiopental sodium was alternatively used as therapeutic agent. RESULTS: Out of 9 RSE treated with midazolam, 5 were resolved. Four unresolved RSE received additional thiopental sodium. Thiopental sodium was initially administered in 5 out of 14 RSE. Among the 5 RSE improved by midazolam, no one had midazo-lam- induced hypotension or pneumonia. Three patients had respiratory suppression and needed artificial ventilation. RSE was controlled in 2 out of 4 patients treated with thiopental sodium after midazolam. In these patients, hypoten-sion was developed in 3, pneumonia in 2, and respiratory suppression in all. In 5 RSE treated with thiopental sodium alone, RSE were successfully treated in 3 patients. Complications were hypotension in 2, pneumonia/unknown infec-tion in 3, and respiratory suppression in 4. CONCLUSIONS: Midazolam was comparably effective as thiopental sodium in the treatment of RSE, with less adverse effects. We suggest that midazolam be used in the treatment of RSE before thiopental sodium is administered.