Seizures

Simple Partial• Focused area such as temporal lobes or

hippocampi• Fear, anger, sadness, happiness or nausea• Sensation of falling or movement• Unusual feelings or sensations• Altered senses• Derealisation or depersonalisation• Spatial distortion• Déjà vu or jamais vu • Laboured speech or inability to speak

Complex Partial• Unilateral cerebral hemisphere involvement• +/- simple partial as aura preceding• Automatisms• Amnesia• Altered consciousness• Impairment of awareness

Generalised Tonic-clonic Tonic Clonic Myotonic Absence Atonic

Status Epilepticus• 10 minutes of continuous seizure activity• Seizures >5 mins need aggressive management

Midazolam Short-acting benzodiazepine Potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties Fast recovery time and is the most commonly used benzodiazepine as a premedication for sedation Adverse effects include drug interactions, tolerance, withdrawal syndrome, cognitive impairment Enhances the effect of the neurotransmitter GABA on the GABAA receptors resulting in neural inhibition Rainbow et al. (2002) found that midazolam can control seizures as effectively as diazepam in the prehospital

setting. Intranasal midazolam can also result in a comparable time to cessation of seizures to that of intravenous

diazepam (Lahat et al., 2000) Queally (2007) concluded that buccal midazolam may be useful in the community setting in the treatment of

prolonged and serial seizures and the prevention of status epilepticus. Chamberlain et al. (1997) concluded that IM midazolam is an effective anticonvulsant for children with seizures

and an important alternative when IV access is not available. Where intravenous access is unavailable there is evidence from one trial that buccal midazolam is the treatment

of choice (Appleton et al., 2008)(full references & further reading at bit.ly/1ijq712)

Review article

Silbergleit R, Lowenstein D, Durkalski V, Conwit R; NETT Investigators. Lessons from the RAMPART study--and which is the best route of administration of benzodiazepines in status epilepticus. Epilepsia. 2013 Sep;54 Suppl 6:74-7. PMID: 24001080

Patients treated with IM midazolam were more likely to have stopped seizing at emergency department (ED) arrival & were less likely to need emergency medical services (EMS) rescue therapy

Patients treated with IM midazolam were less likely to require any hospitalization or admission to an intensive care unit