SynthesisCNS drugs2015
A Common Reference-Based Indirect Comparison Meta-Analysis of Buccal versus Intranasal Midazolam for Early Status Epilepticus.
Synthesis in CNS drugs, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Recommendations for the community-based management of prolonged convulsive seizures in children in Europe.BMC pediatrics · 2026Guideline
- Pre-hospital and emergency department treatment of convulsive status epilepticus in adults: an evidence synthesis.Health technology assessment (Winchester, England) · 2022Pooled it
- Review
- Epilepsy: Molecular Pathogenesis and Emerging Therapies.MedComm · 2026Review
- Benzodiazepines versus non-benzodiazepine antiseizure medications as first-line agents for status epilepticus: analysis of real word data from a 9-years prospective cohort.Frontiers in neurology · 2025Article
- Bioavailability and Safety of a New Highly Concentrated Midazolam Nasal Spray Compared to Buccal and Intravenous Midazolam Treatment in Chinese Healthy Volunteers.Neurology and therapy · 2022Article
- Acute encephalopathy in children with tuberous sclerosis complex.Orphanet journal of rare diseases · 2021Article
- Article
- Tailoring Midazolam-Loaded Chitosan Nanoparticulate Formulation for Enhanced Brain Delivery via Intranasal Route.Polymers · 2020Article
- Use of Emergency Medication in Adult Patients with Epilepsy: A Multicentre Cohort Study from Germany.CNS drugs · 2018Article
- Observational
- New Non-Intravenous Routes for Benzodiazepines in Epilepsy: A Clinician Perspective.CNS drugs · 2017Review
- Not all that glitters is gold: A guide to critical appraisal of animal drug trials in epilepsy.Epilepsia open · 2016Article
- Treatment of Convulsive Status Epilepticus.Current treatment options in neurology · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntranasal and buccal midazolam have recently emerged as possible alternatives to intravenous or rectal diazepam or intravenous lorazepam in the treatment of early status epilepticus (SE). However, to date no randomized controlled trial (RCT) has directly compared intranasal midazolam with buccal midazolam.
objectiveThe aim of this study was to indirectly compare intranasal midazolam with buccal midazolam in the treatment of early SE using common reference-based indirect comparison meta-analyses.
methodsRCTs comparing intranasal or buccal midazolam versus either intravenous or rectal diazepam for early SE were systematically searched. Random-effects Mantel-Haenszel meta-analyses were performed to obtain odds ratios (ORs) for the efficacy and safety of intranasal or buccal midazolam versus either intravenous or rectal diazepam. Adjusted indirect comparisons were then made between intranasal and buccal midazolam using the obtained results.
resultsFifteen studies, with a total of 1662 seizures in 1331 patients (some studies included patients with more than one episode of SE) were included; 1303 patients were younger than 16 years. Indirect comparisons showed no difference between intranasal and buccal midazolam for seizure cessation (OR 0.98, 95% CI 0.32-3.01, comparator: intravenous diazepam; OR 0.87, 95% CI 0.46-1.64, comparator: rectal diazepam). For serious adverse effects, we found a large width and asymmetrical distribution of confidence intervals around the obtained OR of 2.81 (95% CI 0.39-20.12; comparator: rectal diazepam). No data were available for OR using intravenous diazepam as the comparator.
conclusionsIndirect comparisons suggest that intranasal and buccal midazolam share similar efficacy in the treatment of early SE in children. Intranasal midazolam should be used with caution and under clinical monitoring of vital functions. RCTs directly comparing intranasal midazolam with buccal midazolam are required to confirm these findings.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.