Prehospital intranasal midazolam for the treatment of pediatric seizures

Pediatr Emerg Care. 2007 Mar;23(3):148-53. doi: 10.1097/PEC.0b013e3180328c92.


Background: The local emergency medical services (EMS) council implemented a new pediatric treatment protocol using a Mucosal Atomization Device (MAD) to deliver intranasal (IN) midazolam for seizure activity.

Methods: We sought to compare outcomes in seizing pediatric patients treated with IN midazolam using a MAD (IN-MAD midazolam) to those treated with rectal (PR) diazepam, 18 months before and after the implementation of the protocol.

Results: Of 857 seizure patients brought by EMS to our emergency department (ED), 124 patients (14%) had seizure activity in the presence of EMS and were eligible for inclusion in this study. Of the 124 patients eligible for this study, 67 patients (54%) received no medications in the prehospital setting, 39 patients (32%) were treated with IN-MAD midazolam, and 18 patients (15%) were treated with PR diazepam. Median seizure time noted by EMS was 19 minutes longer for PR diazepam (30 minutes) when compared with IN-MAD midazolam (11 minutes, P = 0.003). Patients treated with PR diazepam in the prehospital setting were significantly more likely to have a seizure in the ED (odds ratio [OR], 8.4; confidence interval [CI], 1.6-43.7), ED intubation (OR, 12.2; CI, 2.0-75.4), seizure medications in the ED to treat ongoing seizure activity (OR, 12.1; CI, 2.2-67.8), admission to the hospital (OR, 29.3; CI, 3.0-288.6), and admission to the pediatric intensive care unit (OR, 53.5; CI, 2.7-1046.8).

Conclusions: The IN-MAD midazolam controlled seizures better than PR diazepam in the prehospital setting and resulted in fewer respiratory complications and fewer admissions.

MeSH terms

  • Administration, Intranasal
  • Administration, Rectal
  • Adolescent
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / therapeutic use*
  • Child
  • Child, Preschool
  • Diazepam / administration & dosage
  • Diazepam / therapeutic use
  • Drug Evaluation
  • Emergencies
  • Emergency Medical Services / methods*
  • Emergency Medical Services / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospital Records / statistics & numerical data
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / therapeutic use*
  • Infant
  • Male
  • Midazolam / administration & dosage
  • Midazolam / therapeutic use*
  • Nebulizers and Vaporizers
  • Retrospective Studies
  • Seizures / drug therapy*
  • Time Factors
  • Treatment Outcome


  • Anticonvulsants
  • Hypnotics and Sedatives
  • Diazepam
  • Midazolam