咪达唑仑鼻腔给药治疗热性惊厥的临床研究

目的 探讨咪达唑仑溶液鼻腔给药对热性惊厥急救的的有效性及安全性.方法 对我院就诊36例热性惊厥儿童随机分成两组,研究组给予咪达唑仑0.2～0.3 mg/kg鼻腔内滴入,以安定0.2～0.3 mg/kg静脉注射给药为对照给,观察开始治疗时间、用药后控制发作时间、自患儿到达医院至发作控制的总时间、在控制惊厥方面的疗效及不良反应等指标.结果 在控制惊厥效果鼻腔内滴入咪达唑仑与静脉注射安定相同.在入院至开始治疗时间鼻腔内滴入咪达唑仑组为[(35.8±4.3)s],明显低于静脉注射安定组[(82.2±16.5)s],差异有显著性(P<0.05);用药控制时间鼻腔内滴入咪达唑仑组为[(162.4±15.6)s],与静脉注射安定组[(164.7±16.8)s]相比,差异无显著性;从入院至控制惊厥总时间上,鼻腔内滴入咪达唑仑组为[(209.2±26.1)s],明显低于静脉注射安定组[(339.6±42.4)s],差异有显著性(P<0.05).两组通过监测心率、呼吸、血压均未发现任何不良反应.结论 咪达唑仑溶液鼻腔给药使用方便,是一种安全、更为快速、有效的治疗热性惊厥的方法.     

小剂量咪达唑仑静脉维持治疗儿童癫痫频繁发作的疗效观察

目的观察小剂量咪达唑仑静脉维持治疗癫瘌频繁发作的疗效及安全性。方法对26例癫痫频繁发作的患儿反复给予肛注水合氯醛、肌注鲁米那、静推安定,仍有抽搐发作,建立咪达唑仑专用通道,给于小剂量咪达唑仑静脉维持直到无抽搐发作。在静脉维持过程中予以心电、血压监测,观察意识状态及呼吸情况。结果本组患儿中最小年龄3个月,最大年龄4．5岁。咪达唑仑控制发作的剂量范围1～3μg/（kg·min）。发作1h内控制者17例;2～3h控制者7例;治疗3h仍未控制者2例。所有病例均未发现血压、心率、血氧饱和度和呼吸状态的变化,亦未出现肝肾功能异常。结论小剂量咪达唑仑静脉维持治疗癫痫频繁发作,疗效确切,安全可靠。     

癫持续状态

癫(癎)持续状态是指持续抽搐超过30 min或在2次意识不清之间的连续惊厥发作.癫(癎)持续状态是临床急症,以全身强直阵挛性发作最为常见.控制癫(癎)持续状态时,采用静脉注射应用药物,可迅速控制惊厥发作,减少和避免脑损伤.癫(癎)持续状态经急救而停止发作后,应进行病因治疗以防止癫(癎)持续状态复发.     

负荷量苯巴比妥静脉注射治疗癫癎持续状态15例

目的探讨负荷量苯巴比妥静脉注射治疗小儿癫癎持续状态(SE)的效果.方法SE患儿15例子10 20 mg/kg负荷量苯巴比妥针,以不超过25mg/min速度静脉推注.发作控制后12 h开始给维持量5mg/(kg·d),分两次静脉推注或口服,12h/次,连用5 d.结果10 min内控制发作9例,10～15 min控制发作6例.6例意识障碍者在6～12h全部恢复,未发现严重不良反应.结论负荷剂量苯巴比妥静脉推注是有效控制SE的方法之一.     

持续静脉滴注咪达唑仑治疗儿童癫癇持续状态

近年来发现咪达唑仑具有抗惊厥作用.2002年7月～2003年3月,我们总结分析了持续静脉滴注咪达唑仑(midazolam)治疗儿童癫癇持续状态(status epilepticus,SE)55例,以探讨其临床应用的有效性和安全性,现报道如下.     

持续静脉滴注咪达唑仑治疗儿童癫癎持续状态

近年来发现咪达唑仑具有抗惊厥作用。2 0 0 2年7月～2 0 0 3年3月,我们总结分析了持续静脉滴注咪达唑仑(midazolam)治疗儿童癫持续状态(statusepilepticus ,SE) 5 5例,以探讨其临床应用的有效性和安全性,现报道如下。对象与方法1.研究对象:本组5 5例,为我院神经科住院患儿,均符合SE诊断标准,即抽搐持续30min以上或抽搐频繁发作,其间歇期意识不能恢复并超过30min ,且均经静脉用地西泮、苯巴比妥;另有5例静脉应用氯硝西泮,2例分别静脉用苯妥英钠和丙戊酸钠等治疗不能控制者。其中男39例,女16例;年龄37d～13岁,其中～3岁35例,～7岁12例,～1…     

咪达唑仑持续静脉推注治疗惊厥持续状态的疗效

目的 观察咪达唑仑持续静脉推注治疗惊厥持续状态的疗效及不良反应.方法 选择以频繁惊厥为主要表现(惊厥持续状态)且按常规方法 抗惊厥治疗无效的住院患儿42例.随机分为2组,对照组21例以地西泮加入葡萄糖溶液持续静脉滴注,研究组则予咪达唑仑持续静脉推注.比较2组疗效,观察2组的药物不良反应.结果 研究组21例患儿中20例惊厥得以完全控制,1例无效,有效率为95.2%,且呼吸道分泌物少,无明显呼吸抑制及其他不良反应.对照组14例惊厥完全控制,7例无效,有效率为67.1%,治疗中均出现呼吸道分泌物增加,2例治疗过程中出现呼吸抑制.2组有效率比较差异有统计学意义(P<0.05).结论 咪达唑仑治疗小儿惊厥持续状态疗效明显,不良反应少,可作为治疗小儿惊厥持续状态首选方法 .     

负荷量的鲁米那合并小剂量安定治疗儿童癫癎持续状态的疗效观察

目的　研究鲁米那的负荷量合并小剂量安定对儿童癫癎持续状态的疗效,探讨其安全剂量。方法选择癫癎持续状态患儿共46例,其中治疗组23例,首先安定0.3mg/kg静脉注射后,给予鲁米那负荷量20mg/kg在30min-1h内静脉滴注,12h后给予维持量5mg/kg,对照组23例,同样首先安定0.3mg/kg静脉注射后,将安定20mg/kg加入250ml生理盐水持续缓慢静脉滴注,将二组疗效进行对照。结果　治疗组惊厥控制时间较对照组短P<0.05,药物的负作用二组无统计学差异,P>0.05。结论　负荷量的鲁米那合并小剂量安定对儿童癫癎持续状态是安全有效的治疗方法。     

咪达唑仑治疗婴幼儿重症病毒性脑炎惊厥持续状态的疗效

目的探讨咪达唑仑治疗婴幼儿重症病毒性脑炎(SVE)惊厥持续状态的疗效。方法 38例SVE婴幼儿随机分为2组。2组均予综合治疗,在使用地西泮后抽搐无效时,治疗组予静脉注射咪达唑仑,对照组予鼻饲100 mg.L-1水合氯醛溶液。观察每组患儿抽搐控制率和抽搐持续时间及不良反应。结果治疗组有效率为90%,对照组有效率为44.4%,治疗组明显高于对照组(P<0.05)。治疗组抽搐持续时间明显短于对照组(P<0.05)。治疗组仅1例患儿在较大剂量[0.5 mg.kg-1.h-1]时出现呼吸抑制。结论 SVE惊厥持续状态时在综合治疗的基础上静脉注射咪达唑仑,可更快控制惊厥,尤其适合于基层临床应用。     

奥卡西平治疗儿童癫(癎)的临床随访研究

目的 探讨奥卡西平治疗儿童癫(癎)部分性发作及难治性癫(癎)的临床疗效和安全性.方法 2005-2006年上海新华医院小儿神经科收治癫(癎)患者52例,其中新诊断和未经治疗癫(癎)部分性发作患者37例为单药治疗组;15例为既往经2种以上抗癫(癎)药正规治疗,发作仍未控制者为添加治疗组.起始剂量5～10 mg/(kg·d),每日2次口服,每5～7 d,增加5～10 mg/(kg·d),目标剂量20～40 mg/(kg·d).观察期为6个月至2年,进行自身对照开放性研究,观察其疗效、安全性及依从性,分析剂量与不同年龄及疗效的关系.结果 单药治疗组有效率为(控制+显效+有效)89.19%,控制率为67,57%,退出率为2.70%;难治组有效率为46.67%,控制率为13.33%,退出率为26.67%.共5例退出,1例因皮疹退出,4例因发作未能控制而退出.小于4岁患儿的平均剂量较年长儿显著增高(P＜0.05).发作减少50%以上的病例的平均剂量较发作减少50%以下者显著增高(P＜0.05).21.15%的病例发生不良反应,包括困倦、头晕、乏力、皮疹等,无低钠血症发生.结论 奥卡西平治疗儿童部分性癫(癎)疗效显著,对难治性癫(癎)的也有一定的疗效,临床应用依从性良好,不良反应较少,安全性好.     

Continuous midazolam infusion as treatment of status epilepticus

Accepted 5 February 1997In a tertiary referral centre, midazolam infusion was tried as treatment for 20 children with status epilepticus over a period of two years. The mean age of the children was 4.07 years. Twelve children with refractory status epilepticus had received intravenous or per rectal diazepam and intravenous phenytoin/phenobarbitone or both before midazolam was given (0.15 mg/kg bolus followed by 1-5 µg/kg/min infusion). Eight children required only midazolam to control the established status epilepticus. The seizures were controlled in 19 children. The mean time required for complete cessation of seizures was 0.9 hours. The mean infusion rate required was 2.0 µg/kg/min. All children had regained full consciousness by a mean of 5.1 hours after discontinuation of midazolam treatment. No metabolic derangement or compromise of vital functions was noted in any of the children. Midazolam infusion is thus an effective and safe therapeutic approach for the management of childhood status epilepticus.     

Status Epilepticus

Status epilepticus is a common neurological emergency in childhood and associated with significant morbidity and mortality. Status epilepticus (SE) has been defined as continuous seizure activity lasting more than 30 min or 2 or more seizures in this duration without gaining consciousness between them. However, the operational definition has brought the time down to 5 min. Management can be broadly divided into initial stabilization, seizure termination, and evaluation and treatment of the underlying cause. Diagnostic evaluation and seizure control should be achieved simultaneously to improve outcome. Seizure termination is achieved by pharmacotherapy. Benzodiazepines are the first line drugs for SE. Commonly used drugs include lorazepam, diazepam, and midazolam. In children without an IV access, buccal or nasal midazolam or rectal diazepam can be used. Phenytoin as a second line agent is usually indicated when seizure is not controlled after one or more doses of benzodiazepines. If the seizures continue to persist, valproate, phenobarbitone or levetiracetam is indicated. Midazolam infusion is useful in refractory status epilepticus. Thiopentone, propofol or high dose phenobarbitone are considered for treatment of refractory status epilepticus. Prolonged SE is associated with higher morbidity and mortality. Long term neurological sequelae include epilepsy, behavioural problems, cognitive decline, and focal neurologic deficits.     

Comparison of the effect of continuous intravenous infusion of sodium valproate and midazolam on management of status epilepticus in children

Background and ObjectivesStatus epilepticus as a pediatric emergency requires rapid seizure control in order to prevent subsequent disabilities. Therefore, the present study was conducted to compare the efficacy and side effects of continuous intravenous infusion of sodium valproate versus midazolam as a third-line treatment of status epilepticus in children.MethodologyThis randomized clinical trial study included all children with convulsive and non-convulsive status epilepticus admitted to the pediatric intensive care unit (PICU) of the Bu-Ali Sina Hospital in Sari City (Mazandaran Province, Iran) who had not responded to first-line treatment with diazepam and second-line treatment with phenytoin or phenobarbital. They were consequently treated with continuous intravenous infusion of sodium valproate or midazolam to control persistent seizures.ResultsThe study comprised 70 patients who were randomly assigned to two equal groups of sodium valproate or midazolam treatment. The mean age of patients in group A (sodium valproate) and group B (midazolam) was 3.97 ± 3.33 and 3.84 ± 2.93 years, respectively. In the present study, the most common etiology of status epilepticus was remote symptomatic, accounting for 35% of cases in the two groups. Sodium valproate was effective in controlling status epilepticus in 91.4% of patients, while midazolam was found to be effective in 85.7% of patients (p > 0.05). Patients who received sodium valproate had shorter seizure duration after administration of the drug compared to those who received midazolam (p = 0.01). Eight patients in the midazolam group and two patients in the sodium valproate group were intubated (p = 0.023). The mean duration of stay in the PICU was 3.2 ± 1.4 and 5.6 ± 2.8 days in groups A and B, respectively, showing a significant difference (p = 0.001).ConclusionAccording to our findings, intravenous infusion of sodium valproate can be used as an effective and relatively safe treatment in children with all types of status epilepticus, especially in challenging situations such as lack of intensive care units or respiratory problems.     

Lidocaine treatment in pediatric convulsive status epilepticus.

BACKGROUND: Convulsive status epilepticus (CSE) may end fatally or leave serious sequelae. CSE treatment, invariably an emergency case, is based upon i.v. benzodiazepines as well as phenytoin, barbiturates or both. The present paper reports efficiency of lidocaine in CSE. METHODS: The effects of lidocaine on patients with CSE due to infectious and non-infectious reasons were compared. Lidocaine was given in 29 episodes of CSE to 49 patients having failed to respond to first-line anticonvulsive drugs, such as diazepam, phenobarbital and phenytoin therapy. Lidocaine was given in doses of 2 mg/kg bolus i.v., and then in 4 mg/kg per h infusion. RESULTS: Mean duration of lidocaine infusion was 14.6 +/- 7.8 h. Effectiveness of lidocaine in patients with CSE was found to be 44.4%. Also, 11 patients responded to a single dose of lidocaine (37.9%), while another two (6.9%) required another dose to suppress their seizures. Patients with seizures attributable to infections were observed to have responded favorably to lidocaine when compared to those with seizures due to epilepsy (37.9% vs 6.8%; P < 0.05). Subsequent epilepsy was found to occur more frequently in patients with a poor response to lidocaine than in patients with a good response (P < 0.05). Adverse reactions to lidocaine were observed in three patients (10.3%), two of them having ventricular arrhythmia. As for the other patient, the focal seizure developed into a generalized one. CONCLUSIONS: Lidocaine seems to be useful for the management of CSE as a rapid-acting anticonvulsant, particularly in patients with CSE due to infections. But further studies with larger number of patients are needed.     

咪哒唑仑与地西泮治疗小儿急性惊厥的对照研究

目的：比较咪哒唑仑（MDL）与地西泮（DZP）治疗小儿急性惊厥的疗效,探讨小儿急性惊厥安全、高效的治疗方法。方法：将120例急性惊厥患儿随机分为MDL组(60例)和DZP组(60例),分别予MDL（0.3~0.5 mg/kg）和DZP(0.5~1 mg/kg)治疗,对出现惊厥反复或呈惊厥持续状态患儿,前组给予MDL维持（每小时1~8 mg/kg）,后组给予DZP维持（每小时0.5~1 mg/kg）或联合苯巴比妥钠治疗,比较两种方法疗效。结果：全部患儿于10 min内惊厥得到基本控制,MDL组与DZP组平均控制时间差异无统计学意义。MDL组与DZP组分别有5例及13例患儿10 min后出现惊厥反复或呈惊厥持续状态。维持治疗后平均控制时间分别为40±32 min和69±24 min,差异有统计学意义 (P<0．05)。两组中无一例出现与MDL及DZP相关的副反应。结论：MDL用于治疗小儿急性惊厥安全、高效,对于惊厥反复或呈惊厥持续状态患儿,疗效优于DZP。［中国当代儿科杂志,2010,12（7）：530-532］     

A comparison of buccal midazolam and rectal diazepam for the acute treatment of seizures

In this study, the authors aimed to evaluate buccal midazolam as a practical and safe alternative medication for children who suffer from seizures in the emergency setting and in home practice or anywhere. The effects and side effects of buccal midazolam and rectal diazepam were compared in the treatment of acute convulsions in 43 children, ranging in age from 2 months to 12 years who were seen at the emergency service of the children hospital. Midazolam was given on the even days of the month and diazepam was given on the odd days. In the midazolam group, the seizures of 18/23 (78%) patients terminated in 10 minutes; however 5/23 (22%) patients did not respond. In the diazepam group 17/20 (85%) patients responded in 10 minutes, but 3/20 (15%) did not respond. Midazolam was found to be as effective as diazepam and the difference was not statistically significant (p<0.05). Response periods of the 2 drugs showed no significant difference (p>0.05). The need for a second drug for seizures that did not stop with the first drug was equal, and the difference was not statistically significant (p>0.05). They did not observe any serious complications. In conclusion, buccal midazolam is safe and as effective as rectal diazepam for the treatment of seizures.     

Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures

Objective To evaluate the safety and efficacy of intranasal midazolam for seizures and various procedures. Methods Prospective randomized study. Total 125 children of all ages of either sex, for seizure episode (n-76) and various invasive and non-invasive procedures (n-49) received either intranasal midazolam (0.2 mg/Kg) or intravenous diazepam (0.3 mg/Kg). Results Mean time from arrival at hospital to starting treatment was significantly shorter in midazolam group compared to diazepam group [2.34±0.90; minute vs 4.61±1.08 minute p<0.001]. Mean time to control seizures after arrival in hospital was significantly shorter in midazolam group compared to diazepam group [5.25±0.86 minute vs 6.51±1.06 minute p<0.001]. Conclusion Midazolam by the intranasal route provides safe and equally effective non-invasive method of sedation for procedures and seizures.     

Efficacy and safety of intravenous sodium valproate versus phenobarbital in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children: a randomised trial

Status epilepticus and acute prolonged seizures are the most commonly occurring neurological emergencies in children. Such events have high morbidity and mortality rates along with poor long-term outcomes, depending on their duration and causes. Therefore, such seizures warrant urgent treatment using appropriate doses of anticonvulsants. Benzodiazepines, phenobarbital, and phenytoin are the most commonly used anticonvulsants for controlling status epilepticus and acute prolonged seizures. However, these medications have several well-known adverse effects. Previous studies on both adults and children have shown the efficacy and safety of rapid infusion of valproate in controlling status epilepticus. However, few well-designed randomised trials have been carried out in children, and there remains a paucity of data regarding intravenous sodium valproate use in children. Therefore, our aim was to compare the efficacy and safety of rapid loading of valproate with those of intravenous phenobarbital in children with status epilepticus and acute prolonged seizures. Sixty children (30 in each group) with convulsive status epilepticus and acute prolonged seizures were enrolled and randomly assigned to receive either valproate or phenobarbital. The main outcome variable was termination of all convulsive activity within 20 min of starting anticonvulsant infusion. Intravenous rapid loading of valproate was successful in seizure termination in (27/30, 90%) of patients compared to phenobarbital (23/30, 77%) (p = 0.189). Clinically significant adverse effects occurred in 74% patients of the phenobarbital group and 24% patients of the valproate group (p < 0.001). In conclusion, rapid loading of valproate is effective and safe in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children. Intravenous valproate should be considered as a suitable choice for terminating status epilepticus and acute prolonged seizures in children.     

A Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children

Objective

The purpose of the present study is to compare efficacy and safety of buccal midazolam with intravenous diazepam in control of seizures in Iranian children.

Methods

This is a randomized clinical trial. 92 patients with acute seizures, ranging from 6 months to 14 years were randomly assigned to receive either buccal midazolam (32 cases) or intravenous diazepam (60 cases) at the emergency department of a children''s hospital. The primary outcome of this study was cessation of visible seizure activity within 5 minutes from administration of the first dosage. The second dosage was used in case the seizure remained uncontrolled 5 minutes after the first one.

Findings

In the midazolam group, 22 (68.8%) patients were relieved from seizures in 10 minutes. Meanwhile, diazepam controlled the episodes of 42 (70%) patients within 10 minutes. The difference was, however, not statistically significant (P=0.9). The mean time required to control the convulsive episodes after administration of medications was not statistically significant (P=0.09). No significant side effects were observed in either group. Nevertheless, the risk of respiratory failure in intravenous diazepam is greater than in buccal midazolam.

Conclusion

Buccal midazolam is as effective as and safer than intravenous diazepam in control of seizures.