Retrospective evaluation of caregiver-administered buccal midazolam for pediatric status epilepticus in a regional core hospital in Japan.

BACKGROUND

Status epilepticus (SE) is a frequent pediatric neurological emergency in which rapid seizure control is needed to prevent neurological injury. Buccal midazolam (Buc-MDL) is a noninvasive first-line benzodiazepine for prehospital pediatric SE; nonetheless, real-world data from geographically constrained regional settings are limited.

METHODS

This retrospective, single-center study was performed at a regional core hospital in Eastern Shizuoka, Japan. Pediatric patients aged ≤ 15 years who received Buc-MDL for convulsive SE between April 2023 and September 2025 were included. Effectiveness was defined as seizure cessation within 10 min after administration, without recurrence within 30 min; respiratory suppression was evaluated as the safety outcome.

RESULTS

Buc-MDL was prescribed for 39 patients and administered in 13 (41 episodes), of which 38 episodes in 12 patients were analyzed. Seizure cessation within 10 min occurred in 30/38 episodes (78.9%; 95% confidence interval 63.7-88.9%), with a median time to cessation of 5 min in effective episodes. Mild respiratory suppression occurred in 4/38 episodes (10.5%); all were managed with oxygen alone, and no airway intervention was required. Respiratory suppression was more frequent in ineffective than effective episodes (37.5% vs 3.3%).

CONCLUSIONS

Buc MDL was effective in this small retrospective cohort, but oxygen-requiring respiratory suppression occurred in 10.5% of episodes and appeared to be more frequent when seizures were not controlled; however, this exploratory association is based on a small sample, causality remains uncertain, and its safety profile warrants cautious interpretation, particularly in light of alternative diazepam intranasal rescue formulations with extensive safety data.