Table 2.
Summary of studies on the use of midazolam for status epilepticus
| Delivery route | Study design | n | Age (years) | SE types | Dosage (mg) | Seizure control (%) | TEAE rate (%) | Frequent TEAE (%) | Ref. |
|---|---|---|---|---|---|---|---|---|---|
| Intravenous | |||||||||
| MDZ | PS, OLS | 19 | 16–87 | RSE | 0.2a bolus then, 1 μg/kg/min | 94.7 | 21 | Pharyngeal hypersecretion | [69] |
|
MDZ vs. i.v. propofol |
ReS | 20 | 17–81 | RSE | 2–12 bolus, then 0.05–0.8a /h | 67 | – | – | [70] |
| Intramuscular | |||||||||
|
MDZ vs. i.v. LZP |
RCT, DB, MC | 102 | 0–102 | SE | 10 | 73.4 | – | Endotracheal intubation (14) hypotension (3) | [48] |
| MDZ vs. i.v. LZP | Secondary Analysis | 120 | 0–17 | SE | 5–10 | 68.3 | Inferior to LZP | Intubation hospitalization ICU care | [52] |
| MDZ vs. rectal DZP | RCT | 100 | 0–16 | SE | 0.3a | 96 | 0 | – | [74] |
| MDZ + p.o. PHT vs. p.o. CBZ | PS, OLS | 38 | – | SE | 15 | 84 | – | Drowsiness | [73] |
| Buccal | |||||||||
| MDZ | OLS, SC | 19 | 0–15 | S, SE | 0.3a | 100 (AS), 50 (SE) | – | [76] | |
| MDZ (s.l.) | OLS, SC | 10 | 23–47 | HV | 10 | – | – | – | [13] |
| MDZ vs. rectal DZP | PS | 22 | 25–68 | SE | 15.5 | 83.3 | 21 | Tiredness ataxia | [77] |
| MDZ vs. rectal DZP | RCT, OLS, SC | 18 | 5–19 | S | 10 | 75 | – | Mild decrease in blood pressure | [75] |
| Intranasal | |||||||||
| MDZ | OLS | 175 | 12–62 | RS | 5–10 | 55 | 40–57 | Nasal discomfort somnolence headache | [80] |
| MDZ vs. placebo | RCT, DB | 292 | 12–65 | RS | 5 | 54 | 2) | Nasal discomfort somnolence | [197] |
| MDZ vs. i.v. MDZ | OLS, CO, SC | 6 | 27–47 | HV | 5 | – | – | Temporary nasal irritation | [58] |
| MDZ vs. i.v. LZP | ReS, SC | 50 | 38.6 (SD 14.0) | S, RS | 3 MDZ or 1–2 LZP | No difference | 30.4 MDZ | Somnolence | [84] |
| MDZ vs. i.v. DZP | RCT | 70 | 0–15 | S | 0.2a | Inferior to DZP | 0 | – | [81] |
| MDZ vs. rectal DZP | PS, RCT, SC | 358 | < 18 | S | 0.2a | Not inferior to DZP | – | Respiratory insufficiency (6) intubation (2) | [14] |
| MDZ vs. rectal DZP | PS, OLS | 24 | 25–69 | RS, SE, RSE | 10 | 82 | Drowsiness (68) local irritation 29) | [83] | |
RCT randomized controlled trial, OLS open-label study, SC single-centre, MC multicentre, DB double-blind, PS prospective study, ReS retrospective study, CO cross-over, HV healthy volunteer, S seizure, RS repetitive seizure, SE status epilepticus, RSE refractory status epilepticus, TEAE treatment-emergent adverse event, i.v. intravenous, i.n. intranasal, i.m. intramuscular, p.o. oral, s.l. sublingual, MDZ midazolam, LZP lorazepam, CZP clonazepam, DZP diazepam, PHT phenytoin, CBZ carbamazepine
aMilligram per kilogram body weight (mg/kg BW)