G223(P) A Community-Based Study on the Acceptability, Efficacy and Safety of Buccal Midzolam in Children with Epilepsy

Background Convulsive status epilepticus is the most common paediatric neurological medical emergency and confers a high degree of morbidity and mortality. Early treatment before admission to hospital is pivotal and thus, an efficacious rescue therapy that can be administered easily, acceptably and safely is paramount. In the paediatric population, rectal diazepam has often been regarded as the first-line therapy; it has shown to be efficacious (inducing remission in 60–80% of patients), however, issues persist regarding its safety, especially the risks of respiratory depression and seizure recurrence. Buccal midazolam has emerged as an efficacious alternative and its use as a rescue therapy in status epilepticus is widely increasing; despite this, little is known about the effectiveness and side-effect profile of buccal midazolam from the perspective of carers. Aims To identify the efficacy, safety and acceptability of buccal midazolam as a rescue therapy in children with prolonged epileptic seizures from the perspective of carers. Methods Community-based face-to-face interviews (existing research had utilised telephone interviews) of 25 patients under the care of our department was undertaken to evaluate the effectiveness, adverse effect profile and acceptability of buccal midazolam as a rescue treatment for prolonged seizures. All children were administered Epistatus, a proprietary oral solution (10 mg/ml). Results The doses administered as rescue therapy varied from 2.5 to 10 mg. We evaluated therapeutic success, time taken for cessation of seizures and necessity for emergency department attendance. We also looked at the development of side-effects, namely respiratory depression and sedation following its administration. 96% of families who had used buccal midzolam found that it usually effective in seizure termination and that it prevented hospital admission in 65% of cases. 100% of our patient cohort who had used both buccal midazolam and rectal diazepam preferred the former due to its easiness of administration, social-acceptability and its lesser sedative effect. Conclusion Our study indicates that buccal midazolam is an efficacious alternative to rectal diazepam and that its use is preferred by patients. Please note Although our current sample size is 32, we plan to increase this to 50 by the time of the conference.