ArticleNeurology2014
High-dose midazolam infusion for refractory status epilepticus.
Article in Neurology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
48 citing papers in PubMed, 108 citations in OpenAlex.
- Impact of healthcare system strain on the implementation of ICU sedation practices and encephalopathy burden during the early COVID-19 pandemic.GeroScience · 2025Article
- Treatment of convulsive status epilepticus in Brazil: a review.Arquivos de neuro-psiquiatria · 2025Review
- Ketamine reduces seizure and interictal continuum activity in refractory status epilepticus: a multicenter in-person and teleneurocritical care study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Article
- Convulsive Status Epilepticus in IndonesiaBalkan medical journal · 2024Article
- Sustained effort network for treatment of status epilepticus/European academy of neurology registry on adult refractory status epilepticus (SENSE-II/AROUSE).BMC neurology · 2024Article
- Status epilepticus in the ICU.Intensive care medicine · 2024Review
- Risk factors and a predictive model for the occurrence of adverse outcomes in patients with new-onset refractory status epilepsy.Frontiers in molecular neuroscience · 2024Article
- Status Epilepticus in Older Adults: Diagnostic and Treatment Considerations.Drugs & aging · 2023Article
- A practical approach to in-hospital management of new-onset refractory status epilepticus/febrile infection related epilepsy syndrome.Frontiers in neurology · 2023Review
- Article
- Why won't it stop? The dynamics of benzodiazepine resistance in status epilepticus.Nature reviews. Neurology · 2022Review
- Anticancer Effects of Midazolam on Lung and Breast Cancers by Inhibiting Cell Proliferation and Epithelial-Mesenchymal Transition.Life (Basel, Switzerland) · 2021Article
- [S2k guidelines: status epilepticus in adulthood : Guidelines of the German Society for Neurology].Der Nervenarzt · 2021Review
- Review and Updates on the Treatment of Refractory and Super Refractory Status Epilepticus.Journal of clinical medicine · 2021Review
- Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management.Aging and disease · 2021Review
- Antiepileptic Drug Therapy for Status Epilepticus.Journal of clinical neurology (Seoul, Korea) · 2021Review
- Treatments for Convulsive and Nonconvulsive Status Epilepticus in Adults: An Expert Opinion Survey in South Korea.Journal of clinical neurology (Seoul, Korea) · 2021Article
- Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive Review by the American Epilepsy Society Treatments Committee.Epilepsy currents · 2020Article
- A Theoretical Paradigm for Evaluating Risk-Benefit of Status Epilepticus Treatment.Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society · 2020Review
- Status epilepticus during correction of hyponatremia in a patient with Alzheimer's disease: A case report.SAGE open medical case reports · 2020Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
objectiveThis study compares 2 treatment protocols allowing low vs high continuous IV midazolam (cIV-MDZ) doses.
methodsWe compared adults with refractory status epilepticus treated with a protocol allowing for high-dose cIV-MDZ (n = 100; 2002-2011) with those treated with the previous lower-dose cIV-MDZ (n = 29; 1996-2000). We collected data on baseline characteristics, cIV-MDZ doses, seizure control, hospital course, and outcome.
resultsMedian maximum cIV-MDZ dose was 0.4 mg/kg/h (interquartile range [IQR] 0.2, 1.0) for the high-dose group and 0.2 mg/kg/h (IQR 0.1, 0.3) for the low-dose group (p < 0.001) with similar duration of infusion. Median time from status epilepticus onset to cIV-MDZ start was 1 day (IQR 1, 3) for the high-dose group and 2 days (IQR 1, 5) for the low-dose group (p = 0.016). "Withdrawal seizures" (occurring within 48 hours of discontinuation of cIV-MDZ) were less frequent in the high-dose group (15% vs 64%, odds ratio 0.10, 95% confidence interval 0.03-0.27). "Ultimate cIV-MDZ failure" (patients requiring change to a different cIV antiepileptic medication) and hospital complications were not different between groups. Hypotension was more frequent with higher cIV-MDZ doses but was not associated with worse outcome. Discharge mortality was lower in the high-dose group (40% vs 62%, odds ratio 0.34, 95% confidence interval 0.13-0.92 in multivariate analysis).
conclusionsHigh-dose cIV-MDZ treatment of refractory status epilepticus can be performed safely, is associated with a lower seizure rate after cIV-MDZ discontinuation, and may be associated with lower mortality than traditional lower-dose protocols. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that midazolam at higher infusion rates is associated with a reduction in seizure recurrence within 48 hours after discontinuation and may be associated with lower mortality.
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Registered trials
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