IM Administration of Benzodiazepines as Good as IV for Epileptic Seizures En Route to Hospital

Paramedics caring for patients with prolonged epileptic seizures have as much success ending the seizures with intramuscular midazolam as they do with intravenous lorazepam.

In a noninferiority study, some 900 patients in status epilepticus who had been convulsing for longer than 5 minutes received either intramuscular midazolam or intravenous lorazepam. The primary outcome, the termination of seizures before arrival in the emergency department, was 73% with the intramuscular benzodiazepine and 63% with the intravenous one.

Writing in the New England Journal of Medicine, the authors point out that their study showed not only that intramuscular midazolam was equal to intravenous lorazepam, but that the differences clearly favored the superiority of intramuscular midazolam.

Dr. J. Stephen Bohan concludes in Journal Watch Emergency Medicine: "Prehospital protocols should instruct use of intramuscular midazolam as the primary treatment for prolonged seizure activity not caused by a correctable condition, such as hypoglycemia."