Utilisation du midazolam intraveineux dans l'état de mal convulsif de l'enfant

Abstract

Background. - Status epilepticus is usually treated by benzodiazepines such as diazepam or clonazepam in association with phenytoin and phenobarbital. Midazolam (MDZ) is a recently developed short-elimination half-life benzodiazepine. Case reports. - Four children, aged 3 days to 4 years, were hospitalized in the pediatric intensive care unit for life-threatening illness and developed status epilepticus. They were given an iv bolus dose of 300 to 500 μg/kg of MDZ immediately followed by a continuous iv infusion at the dose of 100 to 300 μg/kg/h. All seizures stopped within 1 hour after the bolus dose administration. No acute adverse events of MDZ were noted. Withdrawal symptoms in one patient were controlled by progressive reduction of MDZ doses. Neurologic sequelae were noted in three children, secondary to their primitive illness. Conclusions. - High doses of MDZ are effective for treating refractory status epilepticus; optimal dosage and duration of treatment remains to be determined.