[tri-med] FYI - Controlling seizures in the prehospital setting: Diazepam or midazolam?

I am forwarding this article or URL for your information (FYI) as I believe
it may be of interest and is from a reliable source. As always, check the
information with your own doctor or health care professional before starting
or changing any treatments.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyActio
n=showAbstract&doi=10.1046/j.1440-1754.2002.00046.x

Journal of Paediatrics and Child Health
Volume 38 Issue 6 Page 582  - December 2002

Controlling seizures in the prehospital setting: Diazepam or midazolam?
J Rainbow, GJ Browne and LT Lam
Objective: To determine which is the most effective and safe treatment for
controlling seizures in children out-of-hospital: diazepam or midazolam.

Methods: A retrospective review of the medical records of children
presenting to the Emergency Department of the Children's Hospital at
Westmead (CHW-ED) with seizures requiring treatment in the field by
paramedics was carried out over a 4-year period (April 1996 to March 2000).
In New South Wales, children with seizures in the prehospital setting
received 0.5 mg/kg per rectum (p.r.) or 0.1 mg/kg i.v. diazepam until March
1998 and from March 1997 onwards they received 0.15 mg/kg i.m. or 0.1 mg/kg
i.v. midazolam. The main outcome measured was cessation of seizure in the
prehospital setting. Secondary outcomes were time taken to initiate
treatment and the frequency of cardiorespiratory compromise.

Results: Over the 4-year period, 2566 children presented to CHW-ED with a
seizure; 107 children were eligible for entry into the present study. Of
these 107 patients, 62 received diazepam and 45 received midazolam.
Thirty-one (50.0%) in the diazepam group and 15 (33.3%) in the midazolam
group were febrile seizures. Both groups were similar in terms of
demographics and seizure type. A comparison of diazepam with midazolam
showed that both drugs were effective in stopping seizures within 5 min of
drug administration (37.1% cf. 51.1%). Fewer patients in the midazolam group
suffered apnoea (20.0% cf. 29.0%; P< 0.05).

Conclusion: Midazolam controls seizures as effectively as diazepam in the
prehospital setting. Furthermore, midazolam potentially reduces respiratory
depression and time to treatment.


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