BUCCAL MIDAZOLAM: COULD IT BE AN ALTERNATIVE FOR I/V DIAZEPAM FOR ACUTE SEIZURES IN MALNOURISHED CHILDREN

Acute convulsive disorders are the most frequent neurological disorders in children which require emergency drug treatment. Immediate management of a convulsive episode is must as, delay can lead to status epilepticus, which is a significant cause of neurological morbidity and mortality among children. Benzodiazepines especially diazepam is often used as first line and routinely administered intravenously, but this is not a practical route in many peripheral health care facilities. Midazolam by buccal route is another upcoming mode of treatment in view of difficulties associated with securing an intravenous line in convulsing children with motor activity especially at peripheries, homes or even at schools. Being a developing country, malnourished group forms a significant number in our clinical practice so it was worthwhile to examine the issue of buccal midazolam's safety and efficacy in this subset of malnourished children. It was a prospective double blind randomized control trial. Total 80 children who fulfilled the inclusion criteria were randomly allocated by a computer generated table. One group received buccal midazolam and the other, intra venous diazepam. Response was assessed by termination of motor activity [seizures] within 5 minute and nonrecurrence of seizure in next 30min. Any toxic effects of either drug were noted. The mean time elapsed between drug administration from the point of entry to the emergency department was found longer with I/V Diazepam than buccal Midazolam (p>0.05), but not quite statistically significant. The time elapsed between drug administration and control of seizures is shorter for diazepam than buccal Midazolam (p<0.05) and this difference is statistically significant. The total time elapsed between point of entry to the emergency till control of seizures is almost same for Diazepam and buccal Midazolam (p<.05). The non-response rate and recurrence rate was significantly lower with Diazepam group. Malnutrition had no effect on control of seizures.