Implementation of Intranasal Midazolam for Prolonged Seizures in a Child Neurology Practice

Impact of prescribing intranasal midazolam as rescue medication for domiciliary management of acute seizure among children with epilepsy

Prescription pattern of rescue medication like intranasal midazolam (INM) for domiciliary management of seizure is highly variable. The present cross-sectional study was designed to determine the impact of the use of INM on healthcare utilization by those who used INM when compared with those who are not on any rescue medications in a resource-constraint setting. Children with epilepsy aged 1-14 years who have used INM to abort seizure at home (INM group) were compared with those who have not used INM (control group). The baseline demographic and seizure characteristics including the severity of epilepsy were comparable between the INM group (n = 50) and controls (n = 50). The INM group had significantly better knowledge of the correct method of administration when compared with controls [43 (86%) vs. 17 (34%); p < 0.01]. Seizures were aborted in 36 (72%) users in the INM group; of the rest of 14 children, 4 (8%) used it for the second time. The median Interquartile range (IQR) time taken to abort the seizure was 2.5 (1.0, 5.2) min. The need for intensive care admissions was comparable between the INM group and control group, although the number of emergency visits was significantly higher in the former [2.9 vs. 1.4, p = 0.04]. Despite comparable severity of epilepsy and better knowledge of its correct use, children who were prescribed INM required more hospital emergency visits. This study with a limited sample size prompts us to introspect the practice of INM for children with epilepsy.