Midazolam (Versed) is used both acutely to treat SE at presentation and as a continuous anesthetic drip after SE has proven refractory to standard treatment (see below). Acutely, it may be given in intravenous boluses of 0.2 mg/kg (5 to 20 mg). Onset of therapeutic effect is extremely rapid because of high lipid solubility, but its effect is short-lived, and relapses of seizures may be expected. The very short duration of action allows clinical assessment soon after its discontinuation.
Midazolam may be the best intramuscular treatment of SE when this is the only available route.
Clonazepam (Klonopin) appears similar to other benzodiazepines and is popular in Europe, but it is not available in intravenous form in the United States for the treatment of SE.
Reviewed and revised February 2004 by Thaddeus Walczak, MD, MINCEP® Epilepsy Care, Minneapolis, MN
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