Is intranasal midazolam an effective rescue medication in adolescents and adults with severe epilepsy?

The aim of this study was to determine whether intranasal midazolam is a sa fe and effective rescue medication in adolescent and adult patients with se vere epilepsy. This field trial was designed to test the feasibility of the use of intrana sal midazolam as an alternative to rectal diazepam in a cohort of patients with severe epilepsy who require rescue medication as part of their treatme nt. A dose of intranasal midazolam (5 mg if the patient weighed less than 5 0 kg and 10 mg if the patient weighed over 50 kilograms) was prescribed for those who had previously responded to other rescue medication. Midazolam w as prescribed buccally if excessive head movement accompanied seizures. The protocol reverted to the usual rescue medication if there was no response to midazolam within 10 minutes. Vital signs were monitored for half an hour following the administration of the treatment. Twenty-two patients received 84 treatment episodes and 79 of these were con sidered clinically effective. Five treatment failures were recorded, three due to poor technique in delivering the midazolam. Two patients were succes sfully retried on midazolam and a third is awaiting a retrial of this drug. The two other treatment failures received the drug buccally. In the first patient the clinical opinion was that this was possibly a psychogenic non-e pileptic seizure. The other patient responded initially, but within an hour had another seizure requiring further rescue treatment. No significant adv erse effects were reported. Our study shows that intranasal midazolam, when used appropriately, is an e ffective treatment in those who require rescue treatment. There are clear a dvantages in the use of midazolam over diazepam in the treatment of acute s eizures. These include the favourable pharmacokinetic and pharmacodynamic p roperties of midazolam as well as the potential of a more acceptable and di gnified administration route. (C) 2000 BEA Trading Ltd.