Intravenous midazolam for the treatment of refractory status epilepticus

Objective: To determine the usefulness of midazolam as a therapeutic agent for status epilepticus refractory to conventional treatment. Design: Retrospective study. Setting: ICUs of two university hospitals. Patients: Seven patients with refractory status epilepticus who failed treatment with diazepam, lorazepam, and phenytoin, with or without phenobarbital. All patients received mechanical ventilation before receiving midazolam. Interventions: Intravenous midazolam by bolus administration followed by infusion. Measurements and Main Results: Midazolam terminated status epilepticus in all patients in <100 secs, as determined by clinical observation (three patients) or electroencephalographic monitoring (four patients). One patient developed mild hypotension. Conclusions: In this small study, midazolam appears to be an effective and safe alternative to high-dose barbiturate coma for the termination of status epilepticus when conventional agents have failed.