Neurology: High-dose midazolam is safe and effective in the treatment of refractory epilepsy

Neurology: 

High-dose midazolam is safe and effective in the treatment of refractory epilepsy:

Research points: The efficacy of high-dose and traditional low-dose midazolam in the treatment of refractory epilepsy. The high-dose group had lower seizure rates and mortality than the traditional low-dose group. Midazolam is a commonly used drug for refractory epilepsy. For patients with refractory epilepsy, it can be completely controlled within 45 minutes, and there is no obvious change of blood pressure, heart rhythm and respiratory depression. After 1.6 h, the average recovery consciousness is completely restored. , Midazolam is safe and effective. Under the current mainstream evidence-based medicine, what is optimal for patients is becoming more and more important. In response to this situation, Dr. Andres Fernandez from the Department of Neurology, Columbia University Medical Center, New York, and others conducted a study to compare high- and low-dose continuous intravenous infusion of midazolam (cIV-MDZ). The effect of refractory status epilepticus in order to make the best decisions for patients. The findings, published online December 20, 2013 in Neurology, suggest that high-dose continuous intravenous infusion of midazolam has proven safe in the treatment of refractory epilepsy, compared to traditional low-dose regimens. Seizure rates and patient mortality are lower. The study was conducted in adults who were treated for refractory status epilepticus. The study compared high-dose continuous intravenous infusion of midazolam (n = 100; 2002–2011) with continuous intravenous infusion of lower doses. Differences in the dalazolam group (n = 29; 1996–2000), data collected from the study included baseline characteristics, duration of intravenous infusion of midazolam, status of epilepsy, hospitalization, and clinical outcome. The mean maximum continuous intravenous infusion of midazolam in the high-dose group was 0.4 mg/kg/h (interquartile range 0.2, 1.0), and the low-dose group was 0.2 mg/kg/h (interquartile range 0.1) , 0.3.p < 0.001), the time of intravenous infusion was the same in both groups, and the median duration of epileptic seizures to the high-dose group with continuous intravenous infusion of midazolam was 1 day (interquartile range 1,3) The low dose group was 2 days (interquartile range 1,5, p = 0.016). Research Background: Professor Wu Xun defined refractory epilepsy as frequent seizures, at least 4 times a month, with appropriate anti-epileptic drugs and regular blood drug concentrations within the effective range, at least 2 years of observation, still unable to control and affect Daily life, no progressive central nervous system disease or intracranial space-occupying lesions. At present, there are 6 million patients with epilepsy, 25% of whom are refractory epilepsy. Common iatrogenic refractory epilepsy is often a diagnosis error, the seizure type is not accurate, the drug selection is improper, the dosage is insufficient, the patient forgets the medicine, and the patient Medicine, etc. The status of epileptic seizures. The morbidity rate is extremely high, and it is also an emergency of neurology. Among them, 30%-50% is refractory epilepsy, and the mortality rate can reach more than 30%. Early choice of fast, safe and effective antiepileptic drugs can control the disease. To improve the prognosis is of great significance.