Study and Author (year) Groups Studied and Intervention Results and Findings Conclusions
Intranasal midazolam compared with intravenous diazepam in patients suffering from acute seizure: Javadzadeh et al. (2012)[@147646] 60 patients, ranging from 2 months to 15 years old, experiencing an acute seizure episode and administered either intranasal midazolam 0.2mg/kg or IV diazepam 0.3mg/kg. Time needed to control seizure:
Intranasal midazolam: 3.16 ± 1.24 minutes
IV diazepam: 6.42 ± 2.59 minutes
Intranasal midazolam has shown superiority in regard to time needed for seizure cessation compared with IV diazepam. This, along with ease of use by non-medical caregivers, makes intranasal midazolam the preferred drug of choice for pediatric seizure rescue.
Comparison of intranasal midazolam versus intravenous lorazepam for seizure termination and prevention of seizure clusters in the adult epilepsy monitoring unit: Owusu et al. (2019)[@147649] 50 patients ≥ 18 years old experiencing epileptic seizures requiring rescue therapy. 27 patients received IV lorazepam, and 23 patients received intranasal midazolam. Median duration of index seizure:
1.7 min (IQR 1.1-2.7) with IV lorazepam
2.0 min (IQR1.5-2.6) with intranasal midazolam
Number of subjects requiring repeat BZD administration:
8/27 (29.6%) with IV lorazepam
7/23 (30.4%) with intranasal midazolam
Intranasal midazolam is comparable with IV lorazepam for seizure termination and seizure cluster prevention. The benefit of bypassing the need for IV access makes intranasal midazolam the preferred choice for seizure control over IV lorazepam.
Intranasal midazolam vs. rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy: Holsti et al. (2010)[@147650] 92 pediatric patients experiencing seizure activity were given either intranasal midazolam (50 patients) or rectal diazepam (42 patients) by a caregiver. Median time to seizure cessation following drug administration:
3.0 min with intranasal midazolam
4.3 min with rectal diazepam
Median seizure time:
10.5 min with intranasal midazolam
12.5 min with rectal diazepam
No differences were seen in regard to adverse effects due to drug administration.
Intranasal midazolam is more effective than rectal diazepam regarding the time needed for seizure control in pediatric patients in the home setting. Caregivers reported that intranasal midazolam was easier to administer than rectal diazepam, making this the drug of choice for seizure control in the home setting.