| Objective:To study the clinical effect of midazolam on status epilepticus (SE) in childhood.The safety of midazolam and its influences on EEG also were discussed.Methods:107 patients which were consistent with the diagnostic criteria of SE were included in this study. All patients were divided into the control group and oberservation group according to odd-even number of admission date. For 54 patients, midazolam were continuously given by continuous intravenous pump infusion. As a control,53 patients were given traditional antiepileptic drugs, it was phenobarbital and diazepam were given alternately, and 5% chloral hydrate was given by retention enema when the onset couldn't be controlled. The following points were observed:(1)Both the curative effect and side effect were observed in two groups. (2)For the. group treated with midazolam, we discussed the curative effect between primarily and secondarily seizure, generalized and focal seizures, the group of≦ages and the one of>3ages, the group whose duration of SE≦24hours and the one>24hours before the treatment with midazolam.(3) We compared the time of the effective ones with generalized seizures and partial seizures in the treatment group, as well as the duration of SE between effective and ineffective groups before the treatment of midazolam. (4)For the control group, to the patients who were invalid after being given Phenobarbital and diazepam, we observed the effect when the medicine changed to midazolam.(5)The safe and effective dose of midazolom, the onset time,the convulsion time, medication time, the time to fully recovery were systematic observed and compared with the control. (6)For the midazolom group, EEG were compared before and after the treatment with midazolom.Results:(1) The therapeutic ratio was 75.9% for the midazolom group, and it was higher than 56.6% for the control group (P<0.05). (2) Midazolam was effective on all types of seizures. However,94.7% of primary SE efficient in the treatment group, was higher than 65.7% of secondary SE, the difference was statistically significant (P<0.05).In the treatment group, generalized seizures efficacy of 91.9%,compared with partial seizures efficacy of 41.2%, the difference was statistically significant (P<0.005). the efficacy of the duration of SE≦24 h before the treatment with midazolam was 92.7%, while the one of SE>24h was 23.1%,the difference was statistically significant P<0.05); On the contrary, there was no significant difference between the group of≦3ages (as the efficient of 78.8%) and the one of>3ages(71.4%)(P>0.05) (3) The seizure in 41 patients was completely controlled with the treatment of midazolam and the median controlled time to the generalized seizures was 0.52h (12 min～20 h), which was significantly shorter than it to the partial seizures,18.8 h (0.6 h～42 h), the difference was statistically significant (u=4.45, p<0.01).For the treatment group, the duration of the former SE in the effective group was 15.25±6.13h,which was shorter than ineffective group,36.31±8.14h, the difference was statistically significant (P<0.05). (4)For the 23 patients whose onset can't be controlled by Phenobarbital and diazepam(refractory status epileptics, RSE), the diazepam was changed to midazolom, then SE stopped in 18 patients, and the effective rate was 78.3%. (5) There weren't abnormal metabolism and vital signs range from 1 to 8μg.kg-1min-1 as the dose of midazolom, and the average effective dose was 3.7μg.kg-1min-1, the average convulsion controlled time was 5.23±4.26 min,the average medication time was 35.45±10.25h,and the average time to full restoration was 4.12±1.25h. All data were obviously lower than those in the control group.(6) Synchronism EEG monitored on 22 cases, the spike and slow waves were inhibited significantly and gradually in 15 cases when midazolam increased to above the 3μg.kg-1min-1.Conclusion:Midazolam is a kind of new AEDs, which is safe, reliable, convenient, with little side effects and onset rapidly. It also has a very wide range of treatment and a high therapeutic index. Midazolam was effective on all types of seizures. However, in the treatment group,primary SE efficient was higher than secondary SE. Generalized seizures efficacy was higher than partial seizures. The efficacy of the duration of SE≦24 h before the treatment with midazolam was higher than the one of SE>24h.Midazolom could suppress epileptic discharges in EEG effectively and should be recommended as first-line AEDs in clinical for the reason that it may still be effective on RSE when conventional first-line anti-epileptic drugs were invalid. |
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