Efficacy of midazolam in the Treatment of Acute Convulsions in Children and Its Effects on Convulsive Brain Tissue Injury

Abstract

This study focused on addressing the efficacy of midazolam in the treatment of acute convulsions in children and its effects on convulsive brain tissue injury.

A total of 124 children with acute convulsions were separated into the control group and the observation group according to the random number table method. Children in the control group received intravenous injection therapy with diazepam (0.3–0.5 mg/kg); those in the observation group received midazolam buccal mucosa administration treatment (different doses for different age groups). The total effective rate of treatment and adverse reactions were observed. The number of children whose convulsions were controlled within 1, 3, and 5 minutes after medication, the time to initial convulsion control, the number of children who experienced recurrence within 10 minutes after control, and the time to recurrence control were recorded. Juvenile (21-day-old) Sprague-Dawley rats were separated into blank control, model, low-dose midazolam, medium-dose midazolam, and high-dose midazolam groups. Rats in the midazolam groups were injected intraperitoneally with different doses of midazolam. The convulsive model rats were prepared by intraperitoneal injection of pentylenetetrazol, and the emergence time and duration time of convulsions were recorded. The convulsion grade of rats was evaluated. The rats were euthanized, and their brain tissues were taken. The pathological morphological changes in the brain tissues were observed, and glial fibrillary acidic protein (GFAP) and gamma-aminobutyric acid (GABA) expression levels in the brain tissues were tested.

The observation group demonstrated a higher total effective treatment rate, a greater number of children whose convulsions were controlled within 3 and 5 minutes of treatment, a shorter average time to convulsion control, a lower recurrence rate within 10 minutes after initial control, a shorter time to control recurrent convulsions, and a lower incidence of adverse reactions compared to the control group. Convulsive model rats that received medium- and high-dose midazolam displayed prolonged emergence time of convulsions, shorter duration, and lower convulsion grade. In convulsive model rats, the nucleus of hippocampal neurons was deeply stained and showed pyknosis; the arrangement of neurons was disordered; the cells were loose and edematous. In the convulsive model, rats received medium- and high-dose midazolam, and the neuron pyknosis and cell oedema were alleviated. In the hippocampus of convulsive model, rats received high-dose midazolam, GFAP expression levels were reduced, and GABA expression levels were raised (p < 0.05).

For children with acute convulsions, midazolam buccal mucosa administration can rapidly control convulsive seizures and reduce recurrence rates with high safety. High-dose midazolam can ameliorate brain tissue injury in convulsed rats, reduce GFAP expression levels in hippocampal tissue, and increase GABA expression levels.