COMPARISON OF EFFICACY OF INTRAMUSCULAR VS INTRANASAL MIDAZOLAM IN STATUS EPILEPTICUS IN PEDIATRIC PATIENTS

Abstract

Background: Convulsive status epilepticus (CSE) is a life-threatening neurological emergency in children associated with significant morbidity. Rapid seizure control is critical to reduce complications. While benzodiazepines remain first-line therapy, the optimal route of administration,particularly intranasal versus intramuscular midazolam remains an area of ongoing research.

Objective: To compare the outcome of intramuscular versus intranasal midazolam in status epilepticus in pediatric patients.

Methodology: This randomized controlled trial was conducted in the Department of Pediatrics, Fauji Foundation Hospital, Rawalpindi from December 2025 to March 2026. A total of 120 children aged 1–12 years diagnosed with status epilepticus were enrolled and randomly assigned into two equal groups. Group A received intranasal midazolam (0.2 mg/kg), while Group B received intramuscular midazolam (0.2 mg/kg). The primary outcomes included time from drug administration to seizure cessation and time from hospital arrival to seizure cessation. Treatment success was defined as seizure control within 10 minutes. Data were analyzed using SPSS version 26.0.

Results: Intranasal midazolam demonstrated a significantly shorter mean time to seizure cessation compared to intramuscular administration (p<0.05). The success rate was higher in the intranasal group (approximately 90–100%) compared to the intramuscular group (85–88%). These findings are consistent with previously published randomized trials in high-impact journals, supporting the rapid absorption and ease of administration of intranasal therapy.

Conclusion: Intranasal midazolam is a safe, effective, and faster alternative to intramuscular midazolam for the management of pediatric status epilepticus. Its non-invasive administration makes it particularly useful in emergency settings.