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Estado de mal epiléptico Status epilepticus  [cached]
Eliana Garzon
Journal of Epilepsy and Clinical Neurophysiology , 2008,
Abstract: INTRODU O: O estado de mal epiléptico (EME) é subdiagnosticado, especialmente as formas clínicas com sinais motores sutis ou apenas com altera o da consciência. é uma emergência neurológica que necessita diagnóstico imediato e a tratamento agressivo e para prevenir les o neuronal. OBJETIVOS: Revisar, discutir e propor protocolo para o tratamento desta condi o. METODOLOGIA: A literatura foi selecionada a partir de pesquisa nas bases de dados MEDLINE e PUBMED. RESULTADOS: Propomos um protocolo utilizando diazepam, fenitoína, fenobarbital, midazolam, thiopental e pentobarbital ainda nos casos refratários topiramato ou levetiracetam. CONCLUS ES: Um protocolo estruturado para a investiga o da etiologia e tratamento do EME é necessário e possibilita melhores chances de evolu o dos casos. INTRODUCTION: Status epilepticus (SE) is an under recognized medical emergency, especially subtle SE or clinical presentation mostly with conscience disturbance (nonconvulsive SE). It is a medical emergency that requires immediate and aggressive diagnoses and treatment. OBJECTIVES: Review, discuss and a protocol suggestion for treatment. METHODOLOGY: Literature publication was selected from MEDLINE and PUBMED. RESULTS: A protocol with diazepam, phenytoin, phenobarbital, midazolam, thiopental and pentobarbital, including topiramate and levetiracetam for refractory cases was proposed. CONCLUSIONS: A standardized protocol for SE work-up and treatment is useful and probably improves outcome.
Estudo comparativo n?o randomizado do midazolam versus thiopental em crian?as com estado de mal epiléptico refratário
Arquivos de Neuro-Psiquiatria , 2000, DOI: 10.1590/S0004-282X2000000200013
Abstract: we evaluated the use of midazolam versus thiopental in 50 children with refractory status epilepticus (rse), admitted in a pediatric intensive care unit. the study consisted of two groups of patients: group a - midazolam, a prospective study, and group b - thiopental, a historical group. these patients already had previous medication with benzodiazepin and diphenylhydantoin and other drugs. when there was no effective control of the seizures, the patients of group a received midazolam of 200 mg/kg intravenous in bolus, being followed by continuous intravenous infusion at the rate 0.25-15m/kg/min. group b received thiopental 1 mg/kg intravenous in bolus followed by continous intravenous infusion at the rate of 10-120 mg/kg/min. in relation to the time of seizure control and effectiveness, there was no statistical significance for the two groups. the midazolam group had significantly less complications during the treatment: less cyanosis (p=0.00006), and they did not need respiratory support (p<0.00001). when the therapy with midazolam was ceased, 12.5% of the patients from this group showed psychological disorders such as mental confusion, aggressive behavior, restlessness, hallucinations and agitation.
Comparing the Effect of Intravenous Midazolam with Rectal Sodium Valproate in Controlling of Children with Refractory Status Epilepticus  [cached]
T Mahmoudian,M Najafian
Journal of Research in Medical Sciences , 2006,
Abstract: Background: Refractory status epilepticus usually defined as a seizure lasting at least 60 minutes which is uncontrollable by Diazepam, Phenytoin, or Phenobarbital. The aim of this study was to compare the effect of interavenous Midazolam and rectal Sodium valproate in controlling refractory status epilepticus. Methods: In this case-control study; 76 children with (mean age of 37± 20 months) with refractory status epilepticus were randomly divided into two groups to receive IV Midazolam and rectal Sodium Valproate. The effect of the two drugs were compared in control of seizure during first 20 minutes of treatment. Results: In 84.2 percent of children treated with IV Midazolam, the seizure was under control within 4.5 ± 0.5 minutes, while in 63 percent of those receiving Sodium Valproate, the seizure was completely controlled within 16.5 ± 0.8 minutes (P < 0.00001). Conclusion: The IV Midazolam was more effective than Sodium valproate, but the latter can be used in hospitals or pediatric emergency wards without ICU for controlling of refractory status epilepticus. Key words: refractory status epilepticus, midazolam, sodium valproate
Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in the Treatment of Refractory Serial Seizures in Children
Iranian Journal of Child Neurology , 2012,
Abstract: ObjectiveSerial seizures occur commonly in inpatient epileptic children. This type ofseizure due to its characteristics has a significant impact on the patient’s health.Untreated serial seizures lead to status epilepticus; therefore, finding a moreeffective treatment for such patients is essential. This study was performed tocompare the outcome of intermittent intravenous diazepam in the pediatricneurology clinic and intravenous midazolam in the pediatric intensive care unit(PICU), in order to introduce an alternative treatment for serail seizures.Materials & MethodsIn this study, 38 inpatient children aged 6 mo-15 years with refractory serialseizures were treated by first line antiepileptic drugs and then randomlytreated with either intermittent intravenous diazepam in the neurology ward orintravenous midazolam in PICU.ResultsFourteen (70%) diazepam group patients and 13 (72.2%) midazolam grouppatients had good response to treatment, there was no significant differencebetween the two groups. Four midazolam group patients and two diazepamgroup patients needed mechanical ventilation and were intubated duringtreatment, with no significant difference between the two groups. Durationsof mechanical ventilation and PICU and hospital stay were not significantlydifferent between the two groups.ConclusionIntermittent intravenous diazepam is an effective alternative therapy formidazolam drip in the treatment of serial seizures due to similar therapeuticeffects and fewer side effects.
Estudo comparativo n o randomizado do midazolam versus thiopental em crian as com estado de mal epiléptico refratário  [cached]
Arquivos de Neuro-Psiquiatria , 2000,
Abstract: Avaliamos o uso do midazolam em rela o ao thiopental em crian as com estado de mal epiléptico refratário(EMER). Foram estudadas 50 crian as com EMER, internadas em UTI-pediátrica, composto pelos: Grupo Midazolam(A) (n=24) prospectivo, e o Grupo Thiopental(B) (n=26) histórico. Benzodiazepina e difenil-hidantoina e outros anticonvulsivantes foram previamente utilizadas nos dois grupos. N o havendo o controle das convuls es, no Grupo A os pacientes receberam uma dose de 200 mig/kg midazolam intravenoso em bolo, seguindo-se a infus o intravenosa contínua na raz o de 0,25 a 15 mig/kg/min. No grupo B foi administrado thiopental, uma dose em bolo intravenosa de 1 mg/kg,, seguida de infus o intravenosa contínua na raz o de 10-120 mig/kg/min. Em rela o ao tempo de controle das crises e sua eficácia, n o houve significancia estatística para os dois grupos. No Grupo A houve significativamente menos complica es durante o tratamento: menos cianose (p=0,00006) e menos crian as necessitaram de ventila o assistida (p<0,00001). No Grupo A, 12,5% dos pacientes, na pós-terapia imediata, apresentaram altera es psíquicas, como agita o, confus o mental, alucina o visual.
A Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children  [cached]
Seyed-Hassan Tonekaboni,Farhad Mahvelati Shamsabadi,Seyed-Saeed Anvari,Ali Mazrooei
Iranian Journal of Pediatrics , 2012,
Abstract: Objective: The purpose of the present study is to compare efficacy and safety of buccal midazolam with intravenous diazepam in control of seizures in Iranian children.Methods: This is a randomized clinical trial. 92 patients with acute seizures, ranging from 6 months to 14 years were randomly assigned to receive either buccal midazolam (32 cases) or intravenous diazepam (60 cases) at the emergency department of a children's hospital. The primary outcome of this study was cessation of visible seizure activity within 5 minutes from administration of the first dosage. The second dosage was used in case the seizure remained uncontrolled 5 minutes after the first one.Findings: In the midazolam group, 22 (68.8%) patients were relieved from seizures in 10 minutes.Meanwhile, diazepam controlled the episodes of 42 (70%) patients within 10 minutes. The difference was,however, not statistically significant (P=0.9). The mean time required to control the convulsive episodes after administration of medications was not statistically significant (P=0.09). No significant side effects were observed in either group. Nevertheless, the risk of respiratory failure in intravenous diazepam is greater than in buccal midazolam.Conclusion: Buccal midazolam is as effective as and safer than intravenous diazepam in control of seizures.
Intranasal Delivery of Two Benzodiazepines, Midazolam and Diazepam, by a Microemulsion System  [PDF]
Shafir Botner, Amnon C. Sintov
Pharmacology & Pharmacy (PP) , 2011, DOI: 10.4236/pp.2011.23026
Abstract: Nasal application of benzodiazepines might be an alternative to intravenous administration in acute clinical situations such as seizures emergencies. However, irritation and pain as well as symptoms like teary eyes, dizziness, discomfort, nasal drainage and bad taste usually accompany subject received midazolam and diazepam via the nasal route. The purpose of this study was to evaluate the use of a new alcohol-free microemulsion system as a carrier for diazepam or midazolam given intranasally. Midazolam (base) or diazepam was solubilized in the microemulsion to obtain a high drug concentration of 25 mg/g (2.5% by weight), to provide 2.5 mg drug in 100 µl spray (d ≈ 1.00 g/ml). The nasal absorption of both drugs from the same microemulsion formulation (containing 20% aqueous phase) was found to be fairly rapid after administration of 0.4 mg/kg to rabbits. The absolute bioavailability of diazepam after intranasal administration using this formulation was 33.45% ± 12.36% and the tmax was 18.33 ± 23.09 min, which was twice longer than the tmax obtained after midazolam administration, 9.25 ± 6.75 min. The pharmacokinetic parameters of midazolam in W/O (20% water) microemulsion and their comparison with midazolam in O/W (50% water) microemulsion have shown that both formulations resulted in a relatively short time to reach the peak plasma level (tmax), that is, 9.25 ± 6.75 min and 6.75 ± 5.67 min, respectively. However, the peak plasma levels (Cmax) and the absolute bioavailability (FA) of midazolam were significantly higher after administration of the W/O formulation than those obtained after application of O/W formulation, i.e., 46.62 ± 17.38 µg/ml vs. 15.44 ± 4.00 µg/ml, and 35.19% ± 11.83% vs. 19.83% ± 16.32%, respectively. Our results suggest that the new microemulsion system may be useful for getting rapid-onset of midazolam and diazepam following intranasal administration, resulting in reasonable peak plasma levels and bioavailability, but most importantly, providing a high measure of tolerability and comfort.
Efficacy of Continuous High Dose Midazolam Infusion in Childhood Refractory Generalized Convulsive Status Epilepticus  [cached]
Afshin Fayyazi,Parvaneh Karimzadeh
Iranian Journal of Child Neurology , 2011,
Abstract: bjeciveProlonged and uncontrolled refractory status epilepticus (SE) is a life-threatening medical emergency in children (1,2,3). There is no consensus on the optimal therapy for refractory status epilepticus (1). The aim of this study was to develop a new method for treating patients with refractory status epilepticus.Materials & MethodsTen children with refractory status epilepticus in Mofid Hospital, who did not respond to 10 μg/kg per min of intravenous midazolam, had their dose of midazolam increased to 30 μg/kg per min. All children were monitored for the development of side effects.ResultsTen children with no response to low-dose midazolam were given a higher dose of midazolam, and 5 (50%) children had a good response. These patients had significantly different response to high-dose midazolam.One patient in the high-dose midazolam group was intubated and required mechanical ventilation. The duration of stay in the hospital and PICU and on mechanical ventilation in patients with no response to low-dose midazolam following with other drugs was longer than in the high-dose midazolam group.No death occurred in high dose midazolam group.ConclusionHigh-midazolam dose drip infusion is a safe and effective protocol for refractory status epilepticus in children.
P. Karimzadeh,L. Afshar khas,A. Mosavat
Iranian Journal of Child Neurology , 2009,
Abstract: ObjectiveAbsence status epilepticus (ASE) is a common form of nonconvulsive status epilepcticus. It is characterized by loss of consciousness with spike and wave discharges in EEG simultaneously. The most effective treatment of ASE is diazepam, either infusion or in divided doses; the former is more expensive since patients must be admitted in an Intensive Care Unit. The aim of this study was to evaluate and compare the efficacy of diazepam infusion and parenteral diazepam in divided doses in the treatment of ASE.Materials & MethodsThis randomized controlled clinical trial, enrolled 20 patients with absence status epilepticus. Diagnosis was made based on the clinical manifestations and electroencephalogram (EEG). Prior to treatment, all patients underwent EEG and imaging. Patients were randomized to receive 0.2 mg/kg/h diazepam infusion or 0.2 mg/kg in six daily doses. Clinical and EEG improvements were considered to be optimal responses.ResultsOf the 20 patients studied, 13 (65%) were boys and the remaining 7(35%) were girls. There were no differences between the two groups regarding age and sex (non-significant). Following treatments after 48 hours, 1 week and 1 month respectively, clinical improvement in previous problems (loss of consciousness, ataxia, behavior and speech problems) and EEGs was similar in both groups (p=1). There were controlled seizures in 18 (90%), abnormal CT scans in 5 (25%), abnormal EEGs after treatments in 6 (30%) cases; however no significant differences were seen between the two groups.ConclusionThis study demonstrates that there are no significant differences between treatments of ASE with diazepam infusion and parenteral diazepam in divided doses. Treatment of ASE, with divided doses of diazepam is easier, less expensive and patients do not require to be hospitalized in an Intensive Care unit.
M.R. Salehi Omran,M.R. Edraki
Iranian Journal of Child Neurology , 2009,
Abstract: ObjectiveMidazolam 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.Materials & MethodsOur 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.ResultsMidazolam 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)ConclusionThere 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.
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