Midazolam and pentobarbital for refractory status epilepticus

Pediatr Neurol. 1999 Apr;20(4):259-64. doi: 10.1016/s0887-8994(98)00155-6.


Status epilepticus, a serious, life-threatening emergency characterized by prolonged seizure activity, occurs most commonly in pediatric patients. Although initial therapies with agents such as diazepam, phenytoin, or phenobarbital generally terminate seizure activity within 30-60 minutes, patients with refractory status epilepticus (RSE) lasting longer require additional intervention. High-dose pentobarbital has been the most commonly prescribed agent for the management of RSE in children; however, midazolam has emerged as a new treatment option. This review compares the use of midazolam with pentobarbital in published reports of pediatric RSE. Both drugs effectively terminated refractory seizure activity, although pentobarbital use was complicated by hypotension, delayed recovery, pneumonia, and other adverse effects. Midazolam use was effective and well tolerated, affirming its value in pediatric RSE management.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Adolescent
  • Anticonvulsants / pharmacology
  • Anticonvulsants / therapeutic use*
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Midazolam / pharmacology
  • Midazolam / therapeutic use*
  • Pentobarbital / adverse effects
  • Pentobarbital / therapeutic use*
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / epidemiology
  • Survival Rate
  • Treatment Outcome


  • Anticonvulsants
  • Pentobarbital
  • Midazolam