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Department of Neurology and Epilepsy Research Laboratory, University of California, San Francisco, CA.
The optimal therapeutic approach for the patient with refractory generalized status epilepticus remains to be defined. We describe four patients with refractory generalized status epilepticus who were successfully treated with intravenous midazolam. Each patient had prolonged convulsive status epilepticus unresponsive to standard doses of intravenous benzodiazepines, phenytoin, and phenobarbital. The patients subsequently received midazolam administered as an intravenous bolus (200 µg/Kg) followed by a continuous infusion (0.75 to 11 µg/kg/min) lasting 8 hours to 10 days. Clinical examination and scalp electroencephalographic monitoring documented the cessation of seizure activity within minutes of the loading dose in all patients. No significant adverse effects occurred during midazolam treatment. The one patient with prolonged midazolam infusion required fluid boluses and pressors for moderate hypotension, and the remainder of the patients safely tolerated midazolam despite preexistent hemodynamic instability. All patients recovered and maintained good seizure control. Intravenous midazolam appears to be an effective treatment for refractory generalized status epilepticus, and may represent a substantial improvement over current therapeutic approaches such as pentobarbital anesthesia.
Address correspondence and reprint requests to Dr. Daniel H. Lowenstein, Box 0114, Department of Neurology, University of California, San Francisco, CA 94143.
Supported in part by grants from the National Institutes of Health (NS01424) and the Esther A. and Joseph Klingenstein Fund.
Received December 6, 1993. Accepted in final form March 23, 1994.
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