Abstract Details

Title Efficacy, Safety, and of Midazolam and Diazepam in the Management of Status Epilepticus in Pediatric Patients: A Systematic Review and Meta-analysis with Trial Sequential Analysis and GRADE Assessment

Topic Child Neurology and Developmental Neurology

Presentation(s) S19 - Emerging Therapies in Child Neurology (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective This systematic review and meta-analysis aimed to compare the efficacy and safety of midazolam versus diazepam for the management of pediatric status epilepticus, with a specific focus on the impact of the administration route.

Background Status epilepticus is a life-threatening neurological emergency in children. Benzodiazepines are the first-line treatment, but the optimal choice between the commonly used midazolam and diazepam remains debated, particularly regarding the advantages of different administration routes in acute settings.

Design/Methods We systematically searched four major databases for randomized controlled trials (RCTs) up to November 2024. Nine RCTs involving 1,135 children were included. Meta-analysis was performed using RevMan, with Trial Sequential Analysis (TSA) to control for random errors and the GRADE framework to assess the certainty of evidence.

Results Midazolam demonstrated a statistically significant higher therapeutic success rate (RR=1.13, p=0.01) and a lower treatment failure rate (RR=0.74, p=0.02) compared to diazepam. This superiority was particularly pronounced for buccal midazolam over rectal diazepam. Time to seizure cessation was shorter for midazolam via non-IV routes, though IV diazepam was faster than non-IV midazolam. Midazolam was also associated with a lower risk of seizure relapse. No significant differences were found in major adverse events like respiratory depression or intubation. TSA confirmed the conclusiveness of the efficacy findings.

Conclusions Midazolam is more effective than diazepam for terminating pediatric status epilepticus, especially when administered via the buccal route. Its favorable efficacy profile supports its use as a preferred first-line benzodiazepine, particularly in pre-hospital or resource-limited settings where intravenous access is unavailable. The safety profile between the two drugs appears comparable.

Authors/Disclosures
Ahmed E. Kertam, MBBS PRESENTER	Dr. Kertam has nothing to disclose.
Nourhan Hatem II, MD	Dr. Hatem has nothing to disclose.
Yehia Nabil	Yehia Nabil has nothing to disclose.
Ahmed R. Harb	Mr. Harb has nothing to disclose.
Mohammed Sabri Hassanin, MD	Dr. Hassanin has nothing to disclose.
Mariam A. Mostafa II, MBBS	Dr. Mostafa has nothing to disclose.
Salma Allam, MD	Dr. Allam has nothing to disclose.
Mohamed A. Mostafa II, MBBS	Dr. Mostafa has nothing to disclose.
Israa Abdeen, MBBS	Dr. Abdeen has nothing to disclose.
Long H. Tu, MD, PhD	Dr. Tu has received publishing royalties from a publication relating to health care.

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