[Intramuscular midazolam in the initial treatment of status epilepticus]. / Midazolam intramuscular en el tratamiento inicial del estado epiléptico.

INTRODUCTION: The status epilepticus a serious complication of the epileptic syndrome with high rates of morbidity and mortality. Treatment is aimed to a fast control of the crisis. AIM: To evaluate the efficacy and security of intramuscular (IM) midazolam in the initial treatment of status epilepticus. PATIENTS AND METHODS: A prospective open clinical trial that included 43 status epilepticus in 38 adult patients. All of the cases received an initial dose of 15 mg IM of midazolam, with a simultaneous oral dose of phenytoin (15 to 20 mg/kg) or carbamazepine (15 mg/kg). If there was immediate control of the seizure but recurrence occurred during the next hours, 15 mg im of midazolam every 8 hours were given, for 24 hours. If there was immediate failure intravenous (IV) midazolam was given. RESULTS: 36 of the 43 status epilepticus were controlled: 30 with only one dose, 3 required additional IM doses, and 3 needed administration of IV midazolam, no patient had neither cardiovascular, respiratory or local complications. The only adverse effect was drowsiness in a variable grade. CONCLUSIONS: The use of IM midazolam is suggested as the initial treatment in status epilepticus in adults, especially in a low complexity setting, due to its effectiveness, quick action and security.

Midazolam intramuscular en el tratamiento inicial del estado epiléptico / Intramuscular midazolam in the initial treatment of status epilepticus

Introducción. El estado epiléptico es una complicación grave del síndrome epiléptico que presenta tasas elevadas de morbilidad y letalidad. El tratamiento se dirige a un rápido control delas crisis epilépticas. Objetivos. Evaluar la eficacia y seguridad del midazolam intramuscular (IM) en el tratamiento inicial del estado epiléptico en el adulto. Pacientes y métodos. Ensayo clínico abierto prospectivo que incluyó 43 episodios de estado epiléptico en 38enfermos. Todos los casos recibieron una dosis inicial de 15 mg IMde midazolam, con una dosis de carga oral simultánea de fenitoína (15-20 mg/kg) o carbamacepina (15 mg/kg). Si hubo control inmediato, pero con recurrencia de las crisis en las horas siguientes, se indicaron 15 mg IM cada 8 horas, durante 24 horas. Ante su fracaso inmediato se administró midazolam en infusión endovenosa (EV).Resultados. Se controlaron 36 de los 43 episodios de estado epiléptico:30 con 15 mg IM por una vez, tres necesitaron administración IM adicional y tres midazolam EV, sin complicación cardiovascular, respiratoria ni tisular local. El único efecto adverso fue somnolencia de grado variable. Conclusiones. Se sugiere el uso de midazolam IM en el tratamiento inicial del estado epiléptico en adultos, especialmente en un ambiente de baja complejidad tecnológica debido a su efectividad, rapidez de acción y seguridad (AU)

Introduction. The status epilepticus a serious complication of the epileptic syndrome with high rates of morbidity and mortality. Treatment is aimed to a fast control of the crisis. Aim. To evaluate the efficacy and security of intramuscular(IM) midazolam in the initial treatment of status epilepticus. Patients and methods. A prospective open clinical trial that included 43 status epilepticus in 38 adult patients. All of the cases received an initial dose of 15 mg IM of midazolam, with a simultaneous oral dose of phenytoin (15 to 20 mg/kg) or carbamazepine (15 mg/kg). If there was immediate control of the seizure but recurrence occurred during the next hours, 15 mg IM of midazolam every 8 hours were given, for 24 hours. If there was immediate failure intravenous (IV) midazolam was given. Results. 36 of the 43 status epilepticus were controlled: 30 with only one dose, 3 required additional IM doses, and 3 needed administration of IV midazolam, no patient had neither cardiovascular, respiratory or local complications. The only adverse effect was drowsiness in a variable grade. Conclusions. The use of IM midazolam is suggested as the initial treatment in status epilepticus in adults, especially in a low complexity setting, due to its effectiveness, quick action and security (AU)

[Treatment of status epilepticus with midazolam: report of four cases]. / Tratamiento del estado de mal epiléptico con midazolam: presentación de 4 casos.

Midazolam is a water-soluble benzodiazepine imide that has been used in recent years to manage status epilepticus (SE). We describe four patients with SE refractory to conventional treatment, whose seizures were controlled with midazolam administered intramuscularly in two cases and intravenously in the remaining two. Given the pharmacokinetic traits of this drug, the intramuscular route offers great advantages. Midazolam also produces fewer side effects than do other benzodiazepines, suggesting the possibility of its use as a first line treatment for SE and frequent epileptic seizures.