Article Text

Intranasal midazolam in patients with fits
1. Martin Smith, Consultant,
2. Simon Carley, Consultant

## Abstract

A short cut review was carried out to establish whether intranasal midazolam was effective for stopping fits. Altogether 36 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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Report by Martin Smith, ConsultantChecked by Simon Carley, Consultant

### Clinical scenario

A 14 year old boy with known epilepsy attends the Emergency Department having had a fit at school. His teacher is with him. She tells you that he was fitting for approximately 20 minutes. She also tells you that they have rectal diazepam at school but the staff were reluctant to administer it. You check the patient and find him to be postictal but otherwise well. You wonder if midazolam, which can be administered intranasally, would successfully terminate epileptic fits.

### Three part question

In [a fitting patient with no intravenous access] can [intranasal midazolam] stop [the fit]?

### Search strategy

Medline OVID 1966 to 2005 Feb week 2 and Embase OVID 1980–2004 Week 7: [exp epilepsy/OR epilepsy.mp OR exp seizures/OR seizure$.mp OR convulsion$.mp. OR fit$.mp.] AND [ exp midazolam/OR midazolam.mp. OR exp benzodiazepines/OR benzodiazepines.mp.] AND [exp administration intranasal/OR nasal$.mp. OR nose.mp.]

### Search outcome

Altogether 36 papers were identified. On reading the abstracts four papers were found to be of interest to the question. These four papers are shown in table 4.

Table 4

### Comment(s)

The standard of evidence is poor. Properly conducted trials comparing the efficacy of intranasal midazolam are needed.

## CLINICAL BOTTOM LINE

Intranasal midazolam appears to be effective at controlling seizures.

Report by Martin Smith, ConsultantChecked by Simon Carley, Consultant