Ep. 162: Route of Midazolam Administration for Pediatric Seizures

Welcome to the Prehospital Emergency Care Podcast!

Rapid seizure termination is one of the most important priorities in pediatric prehospital care, yet establishing intravenous access can delay treatment. In this episode, Maia Dorsett and Joelle Donofrio-Odmann speak with Jonathan Mohnkern about his recent systematic review and meta-analysis comparing intranasal and intramuscular midazolam for pediatric seizures. Together, they review the available evidence, discuss the pharmacologic differences between administration routes, examine the implications for EMS protocols and medication dosing, and explore how these findings may influence future prehospital seizure management.

Featured Article:

Mohnkern, J. D., Khalid, A., Ibrahim, M., Dave, V., Chierighini, P. P., Riaño, A. S., ... & Martins Shehan, T. S. (2026). Intranasal versus intramuscular midazolam in pediatric seizure control: a systematic review and meta-analysis. Prehospital Emergency Care, 1-9. https://doi.org/10.1080/10903127.2026.2658592

Additional References:

Shah, M. I., Macias, C. G., Dayan, P. S., Weik, T. S., Brown, K. M., Fuchs, S. M., ... & Lang, E. S. (2014). An evidence-based guideline for pediatric prehospital seizure management using GRADE methodology. Prehospital emergency care, 18(sup1), 15-24.

Shah, M. I., Ostermayer, D. G., Browne, L. R., Studnek, J. R., Carey, J. M., Stanford, C., ... & Lerner, E. B. (2021). Multicenter evaluation of prehospital seizure management in children. Prehospital Emergency Care, 25(4), 475-486.

Remick, K., Redgate, C., Ostermayer, D., Kaji, A. H., & Gausche-Hill, M. (2017). Prehospital glucose testing for children with seizures: a proposed change in management. Prehospital Emergency Care, 21(2), 216-221.

Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., & Barsan, W. (2012). Intramuscular versus intravenous therapy for prehospital status epilepticus. New England journal of medicine, 366(7), 591-600.

Mohammed, M. Z., Elagouza, I., El Gaafary, M., El-Garhy, R., & El-Rashidy, O. (2024). Intranasal versus buccal versus intramuscular midazolam for the home and emergency treatment of acute seizures in pediatric patients: a randomized controlled trial. Pediatric Neurology, 158, 135-143.

Further Resources:

Pediatric EMS Podcast: Managing Prehospital Pediatric Seizures: https://naemsp.org/podcast-pediatric-em/expedite-the-route-simplify-the-dose-managing-pediatric-prehospital-seizures/