Intravenous midazolam for the treatment of refractory status epilepticus

Abstract

To determine the usefulness of midazolam as a therapeutic agent for status epilepticus refractory to conventional treatment. Retrospective study. ICUs of two university hospitals. Seven patients with refractory status epilepticus who failed treatment with diazepam, lorazepam, and phenytoin, with or without phenobarbital. All patients received mechanical ventilation before receiving midazolam. Intravenous midazolam by bolus administration followed by infusion. Midazolam terminated status epilepticus in all patients in less than 100 secs, as determined by clinical observation (three patients) or electroencephalographic monitoring (four patients). One patient developed mild hypotension. In this small study, midazolam appears to be an effective and safe alternative to high-dose barbiturate coma for the termination of status epilepticus when conventional agents have failed.