Abstracts

Rationale: A pilot trial of midazolam administered intravenously (IV) was implemented as first line therapy for status epilepticus (SE) in a pediatric epilepsy monitoring unit (EMU) for patients undergoing monitoring as part of the pre-surgical epilepsy workup. The primary objective was to improve the time from start of the seizure to administration of the rescue medication. In line with evidence based guidelines, lorazepam 0.1 mg/kg (up to 4mg) IV for SE was the first line therapy prior to these studies. However, delays in administration of lorazepam related to refrigeration and dilution prior to administration occurred. Midazolam does not require refrigeration or dilution, and is routinely used in the field for SE (intramuscular administration). Midazolam has a shorter half-life than lorazepam, thereby having a shorter duration of action and quicker patient recovery time, which could facilitate the recording of more seizures and overall higher yield studies in the EMU. Methods: This single-center study included first 10 patients in a single center study at Texas Children's Hospital (TCH) EMU who received midazolam IV as rescue therapy for SE defined as seizure lasting 5 min or longer and for seizure clusters defined as 3 or more seizures within 30 min. Indications for drug administration were SE and seizure clusters and the dose administered was 0.2 mg/kg (max 5 mg/dose) slow IV push every 3 minutes as needed for up to 2 doses. The primary endpoint was defined as the time from start of the seizure to drug administration. Results: The 10 patients had 15 medication administrations. Doses were administered in 4 patients due to SE, 1 with subclinical SE, and 6 patients with seizure clusters. The primary endpoint for SE was a median of 6 minutes (range 5-7 min) and for seizure clusters the endpoint was 9 minutes (range of 2-27 min). When used to abort SE there was resolution within 1 minute of administration and a second dose was not required. Resolution time for seizure clusters is currently under review. The types of epilepsy and additional clinical information related to AED management in these patients will be included as well as data showing a relatively rapid recovery time for these patients such that additional seizures could be captured. Conclusions: Midazolam was administered in a reasonable and safe amount of time for SE. Midazolam was effective in terminating SE and seizure clusters in the EMU patients and because of the shorter duration of action compared to lorazepam, we were able to capture additional seizures in these patients. Future directions include an objective comparison of our results with lorazepam administration times in our EMU. Funding: None