• Antigone S Papavasiliou, Charalambos Kotsalis, Evangelos Paraskevoulakos, Panagiotis Karagounis, Chrysoula Rizou, and Helene Bazigou.
• Department of Pediatric Neurology, Pendeli Children's Hospital, 8 Mandelara Street, Nea Erythraia, Athens, Greece. theon@otenet.gr
• Epilepsy Behav. 2009 Apr 1;14(4):661-4.

AbstractAlthough the efficacy of midazolam in refractory status epilepticus and as a first-line agent in children with established status epilepticus has been reported, differences in starting doses, continuation method, timing of efficacy assessment, and discontinuation pose limitations in deriving a specific protocol for midazolam use. An audit of clinical experience with a protocol of midazolam as first-line agent for impending status epilepticus (defined as a continuous, generalized, convulsive seizure lasting >5 minutes) in 76 episodes of unprovoked convulsive status epilepticus in children 1-15 years old with treatment-refractory epilepsy demonstrated that: (1) repeated bolus midazolam 0.1mg/kg (every 5 minutes, maximum 5) controlled 91% of events; (2) three bolus doses controlled 89% of the episodes, with minimal chance of response beyond that; (3) treating impending status resulted in lower doses (mean 0.17 mg/kg) than reported and infrequent utilization of additional anticonvulsants (9%); and (4) adverse events were infrequent (respiratory depression 13%, assisted ventilation 3%).

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