Early Midazolam Infusion in Pediatric Status Epilepticus: Defining an Early Therapeutic Window for Seizure Control.

BACKGROUND

Status epilepticus (SE) is a neurological emergency with high morbidity and mortality in childhood, where rapid and effective intervention is essential to prevent neuronal injury. Experimental studies suggest that time-dependent loss of GABAergic responsiveness creates an early therapeutic window during which benzodiazepines are most effective for acute seizure suppression.

METHODS

This retrospective study analyzed 63 pediatric patients (mean age 46.5 ± 4.9 months) with first-episode SE treated between 2008 and 2022. Patients were categorized according to the timing of continuous midazolam infusion as early (≤15 min from seizure onset) or late (>15 min). Primary outcome was time to seizure control; secondary outcomes included infusion duration and epilepsy development during two-year follow-up.

RESULTS

Early infusion significantly shortened time to seizure control (21.8 ± 1.5 min vs. 29.3 ± 2.8 min, p = 0.029) and reduced infusion duration (18.4 ± 2.5 h vs. 32.7 ± 7.5 h, p = 0.049) compared with later initiation. Epilepsy developed in 74.6% of patients over two years, with no significant difference between early and late infusion groups (p = 0.079).

CONCLUSIONS

Initiating continuous midazolam infusion within 15 min of seizure onset defines a clinically relevant early therapeutic window for pediatric SE. While infusion timing did not significantly alter long-term epileptogenesis, early initiation was associated with improved acute seizure control and shorter treatment duration, underscoring the importance of time-sensitive intervention in pediatric neuroemergencies.