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

## TL;DR

This study shows that starting midazolam treatment within 15 minutes of a seizure in children improves short-term outcomes, though long-term effects on epilepsy remain unchanged.

## Contribution

The study identifies a 15-minute early therapeutic window for midazolam in pediatric status epilepticus based on clinical data.

## Key findings

- Early midazolam infusion reduced time to seizure control by nearly 8 minutes.
- Early treatment was associated with shorter infusion duration by over 14 hours.
- Epilepsy developed in 74.6% of patients, with no significant difference between early and late groups.

## Abstract

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.