Medical News Stories
Intramuscular Versus Intravenous Therapy for Prehospital Status Epilepticus
Study Question: Whether intramuscular (IM) midazolam is noninferior to intravenous (IV) lorazepam in prehospital status epilepticus (seizing for at least 5 minutes).
Study Description: This was a randomized, double blind, double dummy, noninferiority trial involving 79 receiving hospitals. Adults and children 13 kg or more were included and administered either 10mg midazolam (5mg for 13kg to 40kg) IM by autoinjector and placebo IV or placebo IM and 4mg lorazepam (2mg for 13kg to 40kg) IV. Patients with major trauma, hypoglycemia, cardiac arrest, or heart rate < 40 beats per minute were excluded.
Results: The primary outcome was termination of seizures prior to arrival without the need for rescue therapy. IM midazolam was noninferior to IV lorazepam (73.4% vs 63.4%, p < 0.001), and superior in a secondary analysis (p<0.001). Additional secondary outcomes revealed decreased hospitalization (57% vs. 65%) and ICU admission (28.6% vs 36.2%) for the IM midazolam group.
Conclusions: IM midazoloam is at least as safe and effective as IV lorazepam for prehospital seizure cessation.
Perspective: The difficulty of gaining IV access for patients in status epilepticus and the refrigeration requirement make injectable lorazepam less than desirable in an out of hospital situation. This study suggests IM midazolam is a therapeutic alternative and possibly a superior therapy in this situation. Important to note is that the study used an autoinjector, which may have decreased time to administration but is not available commercially.