Abstracts

RATIONALE: Rectal diazepam (RD) has become the standard first-line treatment for serial (SS) and prolonged convulsive epileptic seizures (CSE) at home, in school and by paramedics attending emergencies outside hospital in the UK. During tonic seizures it can be difficult, and in public areas undignified and embarrassing. Buccal Midazolam (BM) has been reported to be an effective and convenient alternative (Scott et al., 1999, Lancet:353;623-626, Chattopadhyay et al., 1999, Lancet:353;1798). We therefore undertook a prospective pragmatic audit of its use at home. This study was not a RCT as efficacy in a RCT has already been demonstrated, but an observational study of practicality. METHODS: 31 children attending a regional pediatric neurology service in the last 18 months were offered BM following informed consent. The intravenous preparation was supplied (Hypnoval 10mg/2ml, Roche). The parents or carers were instructed in buccal administration of 5mg for pre-school children, 10mg for school aged children for SS or CSE, as for RD use or for CSE lasting more than 10 min. A standard data sheet was supplied with each ampoule to record what happened prospectively. Main out-come measures were time from BM administration to seizure stopping and associated adverse events. RESULTS: 13 children (6 male, age 2-15 years), had BM treatment on 32 occasions (22 CSE, 10 SS). BM was given between 2 and 720 mins. after SS or CSE onset. 22/32 (69%) seizures stopped between 1 and 10 min. after BM (mean 5 min.), 28/32 (89%) stopped within 30 min. (mean 9 min.). 5/28 (18%) seizures recurred between 20 min. and 15 hours. Episodes were followed by sleep (24/28), hyperactivity (2/28), ataxia for more than 24 hours (1/28), odd behaviour (1/28), mild respiratory depression requiring no intervention (1/28). 1/13 parents found it difficult to administer. 11/12 parents who had previously used RD declared a preference for BM. CONCLUSIONS: We found further evidence for the efficacy of BM, used outside hospital, by parents and carers. No serious adverse events were seen in 32 episodes (95% CI 0-10%). BM was preferred by parents. A ready-to-use BM preparation would be better.