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Intranasal and buccal midazolam in the pre-hospital management of epileptic tonic-clonic seizures

02 August 2014
Volume 6 · Issue 8


Epilepsy is a common neurological condition causing seizures or convulsions. This article looks to analyse the treatment and management of a patient suffering from a prolonged epileptic tonic-clonic seizure by the administration of two common benzodiazepines: midazolam and diazepam. Epileptic seizures carry high risks of secondary injury and the potential for long-term neurological damage; therefore, it is imperative that paramedics can provide swift and effective treatment for these patients. With current advances in pre-hospital care, paramedics should be aware of the latest advances in techniques, management and the associated legal issues. This article will look specifically at the administration of benzodiazepines and in particular the comparison between midazolam and diazepam and the routes of administration available.

This article will compare the use of two common anti-convulsants: midazolam (intravenous, intranasal and buccal formulations) and miazepam (intravenous and per-rectum formulations), in the treatment of prolonged tonic-clonic epileptic seizures. With epilepsy affecting approximately 50 million people worldwide and greater than half a million people within the United Kingdom alone (The Epilepsy Society, 2011), it is important to ensure that paramedics are providing the most effective treatment possible. This article will explore the pathophysiology of epilepsy and an acute seizure, specifically the tonic-clonic presentation as they require rapid therapeutic interventions by paramedics because prolonged seizures may result in complications for the patient. It will then explore the pharmacology of benzodiazepines and compare midazolam administered via intranasal, buccal and intravenous routes with intravenous and rectal diazepam, and the benefits of alternative routes of administration. With recent changes to legislation coming into effect it is important to consider the legal aspects of providing therapeutic interventions with benzodiazepines, which will be discussed later in this article.

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