The Efficacy of Propofol and Midazolam in Treatment of Refractory Status Epilepticus in Children

Background: In this study, we compared the efficacy and safety of propofol and midazolam in treatment of children’s refractory status epilepticus. Methods: We recruited 32 patients with refractory status epilepticus. Of those, 16 were treated primarily with midazolam and 16 received propofol. Results: We achieved complete seizure control in 6 (38%) patients treated by midazolam, and in 10 (63%) of 16 patients receiving propofol. After drug withdrawal, seizure recurred in 2 of 6 children who had complete seizure control with midazolam and in 2 of 10 patients who were successfully treated with propofol. Overall treatment with propofol failed in 4 (25%) patients, while in the midazolam group, the failure was 50%. Complications in the midazolam group consisted of bradycardia which led to cardiac arrest in one patient who fortunately recovered following cardiopulmonary resuscitation, and rise in serum creatine phosphokinase in another. Untoward reactions seen in the propofol group included elevated serum creatine phosphokinase in 5 patients and dyslipidemia in another 5. Untoward reactions in children who received propofol consisted of rise in serum creatine phosphokinase in 5 and increase in serum triglyceride and cholesterol in 5 patients. No significant change was observed in the frequencies of apnea, hypotension, sepsis, electrolyte imbalance and median duration of stay in intensive care unit between the two treatment groups. Conclusion: Propofol, if used appropriately, can quickly and effectively terminate episodes of refractory status epilepticus in children.