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At-home nasal midazolam effective for terminating pediatric epileptic seizures

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Epileptic seizures in children can be terminated at home just as well with intranasal midazolam as with rectal diazepam, a comparison study shows.

“The bottom line is that intranasal midazolam using the Mucosal Atomization Device (nasal spray device) is a good alternative to rectal diazepam. It is just as effective, cheap and easy to give with similar side effects,” Dr. Maija Holsti told Reuters Health by email.

Dr. Holsti and her colleagues at the University of Utah explain in the Archives of Pediatrics and Adolescent Medicine for August that the Mucosal Atomization Device “is an applicator placed on the syringe hub that distributes liquid for nasal administration in a 30-micron particle size, coating the mucosa.” This enhances absorption of the drug and rapidly produces effective plasma and cerebrospinal fluid concentrations.

The team randomly assigned the caregivers of 358 epileptic children to administer either 0.2 mg/kg of midazolam (maximum, 10 mg) intranasally via the atomizer or 0.3 to 0.5 mg/kg of diazepam (maximum, 20 mg) rectally when their child next had a seizure lasting more than 5 minutes at home. Ultimately, 92 caregivers gave the study medication for a seizure.

The investigators found the median time to seizure termination after medication administration was not significantly different with intranasal midazolam or rectal diazepam, at 3.0 minutes versus 4.3 minutes (p=0.09). The time taken to administer the drugs was the same, and total seizure times were 10.5 minutes with midazolam and 12.5 minutes with diazepam (p=0.25).

“No differences between groups were identified with respect to the other secondary outcome measures of repeated seizures, need for emergency services, respiratory depression, emergency department visits, or disposition,” the researchers report.

Furthermore, the atomizer device and midazolam are not expensive, Dr. Holsti added. “The Mucosal Atomization Device is available from Wolf-Troy Medical ($2.45). Generic midazolam is roughly $10-15. Diastat (rectal diazepam) is more than $200 a dose.”

Besides, intranasal administration does have another advantage, she noted. “Older patients may prefer getting a treatment that is in the nose and not given rectally for obvious reasons.”

Reference:

Arch Pediatr Adolesc Med 2010; 164:747-753.