Continuous rate infusion of midazolam as emergent treatment for seizures in dogs
Cluster seizures (CS) and status epilepticus (SE) are two of the most common neurological emergencies in dogs. Twenty to forty percent of dogs with epilepsy are not adequately controlled leading many patients to present to the emergency room with SE or CS.
Although treatment of these conditions is required, optimal therapy is still unknown. There is a wide variety of treatment options and the most frequent is the use of diazepam, which is a benzodiazepine that quickly passes the brain barrier after parenteral administration. After an initial bolus, a maintenance anticonvulsant is frequently used. In some cases, this treatment is not enough to control seizure activity and additional therapeutics is necessary.
One option is the use of diazepam as a constant rate infusion (CRI). However, some reported side effects such as phlebitis, photosensitivity and its compatibility with fluid solutions limit its use. Midazolam, despite also being from the same drug category, doesn’t have reports of these side effects.
The goal of this retrospective study consisted in evaluating the use and safety of midazolam as a CRI for the control of emergent seizure episodes.
One hundred and six dogs and a total of 129 periods of midazolam CRI administrations were included. Seizure control was successful in 77.4% and etiology of the episodes was not important in treatment outcome. The median dose of the midazolam CRI was 0.3mg/kg/h.
This study presented some limitations. For example, it was not possible to determine the real efficacy of this type of treatment due to concurrent treatment with other anticonvulsants. Some dogs might have even responded successfully to treatment despite the midazolam CRI.
Regardless of these limitations, it seems that the use of this benzodiazepine as a constant rate infusion is safe and may be an effective treatment in dogs with CS or SE.
Bray, K.Y., Mariani, C.L., Early, P.J., Muñana, K.R., Olby, N.J. (2021) ‘Continuous rate infusion of midazolam as emergent treatment for seizures in dogs’, Journal of Veterinary Internal Medicine, 35(1), pp. 388-396.
