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Buccal Midazolam Compared With Rectal Diazepam Reduces Seizure Duration in Children in the Outpatient Setting

Moretti, Raffaella MD*,†,‡,§; Julliand, Sebastien MD; Rinaldi, Victoria Elisa MD*; Titomanlio, Luigi MD, PhD*

doi: 10.1097/PEC.0000000000001114
Original Articles

Background Seizures are very common in children. They frequently happen in outpatient settings, in the presence of caregivers who are not always trained in their management. First-line rescue therapy is based on benzodiazepine, historically diazepam. Recent studies have investigated the use of other benzodiazepines in the treatment of acute seizures.

Objectives The aims of this study were to evaluate the management of pediatric seizures carried out by parents or caregivers in an outpatient setting and to evaluate the differences in terms of immediate management and subsequent outcome when comparing the use of rectal diazepam versus buccal midazolam.

Methods In this retrospective study, medical records of children consulting for seizures at the Robert Debré Pediatric Emergency Department of Paris, France, over 18 months were analyzed to evaluate seizure characteristics, management by caregivers, received treatments, and the admission rate.

Results Five hundred ninety-four patients resulted eligible for the study. The interview was completed for 135 children who presented a further episode of seizure after inclusion. In the subgroup of children receiving buccal midazolam, compared with the subgroup receiving intrarectal diazepam, seizure duration was significantly shorter (10.3 vs 48.4 minutes, P = 0.0004), and the risk of a status epilepticus decreased (1 vs 11, P = 0.0008). The admission rate was not different between the 2 subgroups.

Conclusions Based on our results, buccal midazolam seems to have some advantages compared with rectal diazepam in terms of feasibility in an outpatient setting and in terms of reduced seizure duration.

From the *Pediatric Emergency Department

Physiology Department, APHP, Robert Debre Hospital

INSERM U1141, DHU PROTECT, Université Paris Diderot, Sorbonne Paris Cité, Paris, France

§Pediatric Department, Università degli Studi di Udine, Udine, Italy

Pre-Hospital Care Unit, SMUR Pédiatrique, Robert Debre Hospital, Paris, France.

Disclosure: The authors declare no conflict of interest.

Reprints: Luigi Titomanlio, MD, PhD, Pediatric Emergency Department, Hôpital Robert Debré–Assistance Publique Hopitaux de Paris, Paris Diderot University, Sorbonne Paris Cité, 48 Blvd Sérurier, F-75019, Paris, France (e-mail:

This study was supported by a grant from Shire, Boulogne-Billancourt, France.

The supporting bodies played no role in any aspect of the study design, analysis, interpretation or decision to publish these data.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Online date: March 27, 2017

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