Peer-reviewed article
Characteristics of withdrawal seizures in children with refractory status epilepticus who responded favorably to continuous midazolam therapy.
Takeuchi H, Kikuchi K, Takeda R, Hirata Y, Matsuura R et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical study of children with refractory status epilepticus (a severe, treatment-resistant seizure condition) who were treated with continuous midazolam medication. The study compares children who stopped having seizures without complications to those who experienced withdrawal seizures when the medication was reduced. The findings suggest that higher doses of midazolam and longer treatment duration may be associated with withdrawal seizures, but the study was too small to confirm this relationship.
Key points
- 19 children with refractory status epilepticus responded to continuous midazolam therapy
- 42.1% (8 of 19) experienced withdrawal seizures when the medication was being stopped
- Children with withdrawal seizures received higher median maintenance doses (0.25 mg/kg/h vs 0.1 mg/kg/h)
- Children with withdrawal seizures had longer treatment duration (52.5 hours vs 27 hours) and higher cumulative doses
- No statistical analysis was performed due to small sample size
Limitations
This is a very small descriptive study without statistical testing, making it impossible to confirm whether the observed differences in dosing and duration actually caused the withdrawal seizures. The study cannot tell us the optimal tapering protocol or whether other factors influenced the outcomes.
Abstract
Background This study investigates the characteristics of children with refractory status epilepticus (RSE) who experienced withdrawal seizures and responded favorably to continuous midazolam (cMDL) therapy. Methods Patients who experienced RSE and achieved seizure cessation with cMDL were included in the study. Withdrawal seizure was defined as a seizure occurring from the initiation of cMDL tapering until 48 h after the discontinuation of cMDL. The patients were categorized into two groups: seizure cessation and withdrawal seizure groups. Results Nineteen patients with RSE achieved seizure cessation with cMDL. The seizure cessation group comprised 11 patients, while eight patients (42.1 %) were classified into the withdrawal seizure group. The median maintenance dose of cMDL were 0.1 mg/kg/h (interquartile range [IQR]: 0.1-0.2) for the seizure cessation group, and 0.25 mg/kg/h (IQR: 0.15-0.3) for the withdrawal seizure group. The median maintenance periods were 27 h (IQR: 12-32.5) for the seizure cessation group, and 52.5 h (IQR: 23-65.5) for the withdrawal seizure group. The seizure cessation group had a median cumulative MDL of 2.7 mg/kg (IQR: 1.6-4.9), while the withdrawal seizure group had 11.6 mg/kg (IQR: 4.5-24.5). Conclusion Although statistical analysis was not conducted due to the small sample size, maintenance dose of cMDL is potentially correlated with withdrawal seizure. A multi-center study with large sample size and statistical analysis of this relationship may contribute to the establishment of an optimized cMDL tapering protocol.