A Comparative Study between Intranasal Midazolam and Intravenous Midazolam In Control Of Seizure In Children

  • Md. Azmat Rana Senior Resident, Department of Pharmacology, Jawaharlal Nehru Medical College, Aligarh
  • Syed Touseef PG student, Department of Pharmacology, Teerthanker Mahaveer Medical College & Research Centre, Moradabad.
Keywords: Midazolam, Seizures, Anti-epileptics.


Introduction: Seizures are one of the important reasons for children visiting the hospital. Febrile seizures are the most common type of seizures found in childhood. Earlier Diazepam was widely used for treating all types of seizures but due to short duration of action, newer drugs were tried and found better than diazepam.

Aims: To compare midazolam given intranasally with midazolam given intravenously for the treatment of febrile seizures in children.

Methods: This prospective study was conducted in children suffering from seizures at the Paediatric Emergency Department of Teerthanker Mahaveer Medical over a period of 12 months. 84 children between the ages of one months to fourteen years with febrile seizures lasting for at least 10 minutes were eligible for inclusion in our study.  Treatment was considered successful if the seizure ceased within one hundred twenty seconds

Results: In group A out of 44 patients, 20(45.5%) patients were responded to Intranasal Midazolam, whereas   in group B 40 patients who were treated with IV Midazolam as first line treatment, 36 patients (90%) had responded to it.  Time recorded for the commencement was more in IV Midazolam group (1.598 min) than IN Midazolam group (0.379 min), but average response time was lesser in group B (1.009 min) than group A (3.001 min).

Conclusion: Midazolam given intranasally is a safe and effective treatment for prolonged febrile seizures in children and may be used in general practice and, with appropriate instructions, by the parents of children with recurrent febrile seizures at home.


Download data is not yet available.


1. Hirtz DG. Generalized tonic­clonic and febrile seizures. Pediatr Clin North Am 1989;36:375­82.
2. Treatment of convulsive status epilepticus: recommendations of the Epilepsy Foundation of America's Working Group in status of epilepticus. JAMA 1993;270:854­49.
3. Alldredge BK, Wall DB, Ferriers DM. Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatr Neurol 1995;12:213­6.
4. Conner JT,Katz RL, Pagano RP, GrahamCW. PO21­3981 for intravenous surgical pre­medication and induction of anesthesia. Anesthesiol Anal 1978;57:1­5.
5. De Jong RH, Bonin JD. Benzodiazepines protect mice from local anesthetic convulsions and death. Anesth Analg 1981;60:385­9.
6 . Jawad S, Oxley J, Wilson J, Richens A. A pharmacodynamic evaluation of midazolam as an antiepileptic compound. J Neurol Neurosurg Psychiatr 1988;49:1050­4
7. Latson LA, Cheatham JP, Gumbiner CH, Kugler JD, Danford DA, Hafschire PJ, et al. Midazolam nose drops for outpatient echocardiography sedation in infants. Am Heart J 1991;121:209­10.
8. Lacon A, Reddy VG. Nasal midazolam and ketamine for pediatric sedation during computerized tomography. Acta Anesthesiol Scand 1994;38:259­61.
9. Wilton NCT, Leight J, Rosen DR, Pandit U. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology 1988;69:972­5.
10. Saint­Maurice C, Landais A, Delleur MM, Esteve K, MacGee K, Murat I.The use of midazolam in diagnostic and short surgical procedures in children.Acta Anesthesiol Scand 1990;94(suppl 92):39­41.
11 .O'Regan ME, Brown JK, Clarke M. Nasal rather than rectal benzodiazepines in the management of acute childhood seizures? Develop Med Child Neurol 1996;38:1037­45.
12 .Lahat E, Goldman M, Barr J, Eshel G, Berkovitch M. Intranasal midazolam for childhood seizures. Lancet 1998;352:620
13. Wermeling DP, Miller JL, Rudy AC. Intranasal delivery. Drug Delivery Technology. 2005; 5(3):44-49.
14. Lacon A, Reddy VG. Nasal midazolam and ketamine for pediatric sedation during computerized tomography. Acta Anesthesiologica Scandinavica. 1994; 38:259-261.
15. Timothy R. Wolfe, MD Intranasal Medication Delivery for Children: A Brief Review and Update.
16. Ahmad, S. Ellis JC, Kamwendo H, Molyneux E. Efficacy and safety of intranasal lorazepam versus intramuscular paraldehyde for protracted convulsions in children: an open randomised trial. Lancet, 2006. 367(9522):1591-7.
17. Fişgin T, Gurer Y, Teziç T et al. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol. 2002 Feb;17(2):123-6.
18. Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T. Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol. 1999;3(2):73-7.
19. D.G.Shirodkar, The comparison between the efficacy of intramuscular midazolam and intravenous midazolam in termination of seizures in children 52nd National conference of Indian Academy of Paediatrics. 2015; January: 22-25.
20. Mahmoudian, T. and M.M. Zadeh, Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav, 2004. 5(2):253-5.
21. Mittal P, Manohar R, Rawat AK. Comparative study of IN midazolam and IV diazepam sedation for procedures and seizures; Indian J of Pediatrics. 2006; 73 (11): 975-8.
22. Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ. 2000; 321(7253):83-6.
How to Cite
Rana MA, Touseef S. A Comparative Study between Intranasal Midazolam and Intravenous Midazolam In Control Of Seizure In Children. Int Arch BioMed Clin Res [Internet]. 2015Sep.3 [cited 2019Oct.17];1(1):23-7. Available from: https://iabcr.org/index.php/iabcr/article/view/247