Melendez R, Batista D, Font D, Bausà T, Hijano A, Rocha A, Elias C
Sección de Neurología. Hospital Universitari Doctor Josep Trueta, Girona.
Neurologia. 2006 Oct;21(8):411-3.
Convulsive status epilepticus is a common major complication of epilepsy that results in high morbidity and mortality. Early treatment of prolonged seizures with rectal diazepam has been the method of choice in order to avoid this complication. However, several randomized trials in recent years suggest that buccal midazolam is as effective and safe as rectal diazepam. This study aims to seek further confirmation of the efficacy and safety of buccal midazolam in daily clinical practice.
Ten out of 73 adult epileptic patients who were residents in a center for people with severe encephalopathy were included. We recorded all seizures over a one-year period. Prolonged seizures, defined as a seizure lasting one minute or longer, were treated by placing buccal midazolam 5 mg (1 ml) between the lower lip and the gum. We administered a second dose of midazolam when the seizure lasted more than two minutes and a third dose of midazolam, or a combination of rectal diazepam 5 mg together with midazolam, as a rescue therapy when the seizure lasted for more than 3 minutes. Vital constants were monitored.
We treated 52 prolonged seizures in 10 patients enrolled in the study. The treatment was effective with a single dose within two minutes in 80.7% of seizures. No cardiorespiratory complications were detected and no patients presented a convulsive status epilepticus.
Buccal midazolam is effective and safe in the treatment of prolonged seizures and has the advantage of being a convenient and socially acceptable administration form.
惊厥性癫痫持续状态是癫痫常见的严重并发症，可导致高发病率和死亡率。为避免这一并发症，早期使用直肠地西泮治疗长时间发作一直是首选方法。然而，近年来的几项随机试验表明，颊部咪达唑仑与直肠地西泮一样有效且安全。本研究旨在进一步证实颊部咪达唑仑在日常临床实践中的有效性和安全性。
纳入了73名重度脑病患者中心的成年癫痫患者中的10名。我们记录了一年期间的所有发作情况。长时间发作定义为持续一分钟或更长时间的发作，通过在下唇和牙龈之间放置5毫克（1毫升）颊部咪达唑仑进行治疗。当发作持续超过两分钟时给予第二剂咪达唑仑，当发作持续超过3分钟时给予第三剂咪达唑仑，或给予5毫克直肠地西泮与咪达唑仑联合使用作为抢救治疗。监测生命体征常数。
我们对研究纳入的10名患者中的52次长时间发作进行了治疗。80.7%的发作在两分钟内单剂量治疗有效。未检测到心肺并发症，也没有患者出现惊厥性癫痫持续状态。
颊部咪达唑仑治疗长时间发作有效且安全，具有给药方便且为社会所接受的优点。
