TREATMENT OF REFRACTORY GENERALIZED STATUS EPILEPTICUS WITH CONTINUOUS-INFUSION OF MIDAZOLAM

The optimal therapeutic approach for the patient with refractory gener alized status epilepticus remains to be defined. We describe four pati ents with refractory generalized status epilepticus who were successfu lly treated with intravenous midazolam. Each patient had prolonged con vulsive status epilepticus unresponsive to standard doses of intraveno us benzodiazepines, phenytoin, and phenobarbital. The patients subsequ ently received midazolam administered as an intravenous bolus (200 mu g/kg) followed by a continuous infusion (0.75 to 11 mu g/kg/min) lasti ng 8 hours to 10 days. Clinical examination and scalp electroencephalo graphic monitoring documented the cessation of seizure activity within minutes of the loading dose in all patients. No significant adverse e ffects occurred during midazolam treatment. The one patient with prolo nged midazolam infusion required fluid boluses and pressors for modera te hypotension, and the remainder of the patients safely tolerated mid azolam despite preexistent hemodynamic instability. All patients recov ered and maintained good seizure control. Intravenous midazolam appear s to be an effective treatment for refractory generalized status epile pticus, and may represent a substantial improvement over current thera peutic approaches such as pentobarbital anesthesia.