كليدواژه :
Status Epliepticus , Refractory Status Epilepticus , Midazolam , صرع پايدار , ميدازولام
چكيده لاتين :
Status epilepticus is a serious life-threatening emergency in pediatric patients. Although initial therapies with agents such as diazepam, phenytoin or phenobarbitai generally terminate seizure activity within 30-60 minutes, patients with refractory status epilepticus lasting longer require additional intervention. Midazolam infusion may act as a safe and effective treatment in these patients. Midazolam (0.15 mg/kg intravenous bolus followed by 1-5 ng/kg/min infusion) was tried as treatment for 15 children with refractory status epilepticus in Tabriz childrenʹs Medical Center. History and physical examination were recorded. Serum electrolytes, urea, creatinin, liver function tests and blood gases were measured before and 24 hours after begining of treatment. Brain computrized tumography scan and electroencephalography were carried out after stabilization of patientsʹ condition. Level of consciousness, respiratory rate, heart rate, blood pressure and arterial oxygen saturation have been recorded during treatment. The required amounts of midazolam and the time to control each seizure attack were also determined. Phenytion and phenobarbitai serum levels were measured before begining of midazolam infusion. The seizures were controled in 11 (73.3%) patients completely. The average required time for complete cessation of seizure attack was 27.9 minutes. The mean infusion rate was 2.18 jig/kg/min. The serum level of phenytion and phenobarbitai was not less than 10 jug/ml in any patients. Midazolam infusion was discontinued in one patient because of need to mechanical ventilation due to respiratory suppression. No patient developed metabolic or electrolyte disturbance. There was no hypotension. Midazolam intravenous infiision, therefore, could be recommended as an effective and relatively safe treatment for refractory status epilepticus.
