***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Status epilepticus ( SE ) is a common neurological and medical emergency . Despite the significant mortality associated with SE , no human data have been available regarding cardiovascular changes prior to death in patients with this condition . This study was conducted to measure hemodynamic trends in the 24 h prior to death in a series of 24 prospect ively evaluated SE patients . Two distinct cardiovascular patterns of mean arterial pressure ( MAP ) and heart rate ( HR ) were observed . Ten patients had a gradual decline in MAP and /or HR , and this group was design ated as having gradual cardiac decompensation ( GCD ) . The remaining 14 patients showed no significant changes in either MAP or HR up to the time of death . This group of patients was design ated as having acute cardiac decompensation ( ACD ) . The changes in MAP and HR over the last 24 h prior to death between the GCD and ACD groups were statistically significant . Ninety percent of the GCD patients had a history of multiple risk factors for arteriosclerotic cardiovascular disease ( ASCVD ) , while only 30 % of the ACD group had a history of multiple risk factors for ASCVD . The results provide the first human data of cardiovascular events immediately preceding death in SE patients . We propose that further investigation of the cardiovascular pathophysiology of SE may provide new therapeutic interventions which could decrease the significant mortality associated with SE BACKGROUND Convulsive status epilepticus is the most common neurological medical emergency and has high morbidity and mortality . Early treatment before admission to hospital is best with an effective medication that can be administered safely . We aim ed to find out whether there are differences in efficacy and adverse events between buccal administration of liquid midazolam and rectal administration of liquid diazepam in the acute treatment of seizures . METHODS At a residential school with on-site medical facilities 42 young people with severe epilepsy were enrolled . Continuous seizures of more than 5 min duration were r and omly treated with buccal midazolam or rectal diazepam . If the seizure did not stop within 10 min additional medication chosen by the attending physician was administered . We monitored oxygen saturation and blood pressure for 30 min after treatment . The main outcome measures were efficacy , time from arrival of the nurse to drug administration , time from drug administration to end of seizure , and incidence of adverse cardiorespiratory events . FINDINGS Buccal midazolam was used to treat 40 seizures in 14 students , and rectal diazepam 39 seizures in 14 students . Midazolam stopped 30 ( 75 % ) of 40 seizures and diazepam 23 ( 59 % ) of 39 ( p=0.16 ) . The median time from arrival of the nurse to administration of medication was 2 min . Time from administration to end of seizure did not differ significantly between the two treatments . No clinical ly important adverse cardiorespiratory events were identified in the two groups . Buccal midazolam was universally acceptable to the nursing and care staff . INTERPRETATION Buccal midazolam is at least as effective as rectal diazepam in the acute treatment of seizures . Administration via the mouth is more socially acceptable and convenient and may become the preferred treatment for long seizures that occur outside hospital BACKGROUND Rectal diazepam and buccal midazolam are used for emergency treatment of acute febrile and afebrile ( epileptic ) seizures in children . We aim ed to compare the safety and efficacy of these drugs . METHODS A multicentre , r and omised controlled trial was undertaken to compare buccal midazolam with rectal diazepam for emergency-room treatment of children aged 6 months and older presenting to hospital with active seizures and without intravenous access . The dose varied according to age from 2.5 to 10 mg . The primary endpoint was therapeutic success : cessation of seizures within 10 min and for at least 1 hour , without respiratory depression requiring intervention . Analysis was per protocol . FINDINGS Consent was obtained for 219 separate episodes involving 177 patients , who had a median age of 3 years ( IQR 1 - 5 ) at initial episode . Therapeutic success was 56 % ( 61 of 109 ) for buccal midazolam and 27 % ( 30 of 110 ) for rectal diazepam ( percentage difference 29 % , 95 % CI 16 - 41 ) . Analysing only initial episodes revealed a similar result . The rate of respiratory depression did not differ between groups . When centre , age , known diagnosis of epilepsy , use of antiepileptic drugs , prior treatment , and length of seizure before treatment were adjusted for with logistic regression , buccal midazolam was more effective than rectal diazepam . INTERPRETATION Buccal midazolam was more effective than rectal diazepam for children presenting to hospital with acute seizures and was not associated with an increased incidence of respiratory depression In this study , the effects and side effects of rectal diazepam and intranasal midazolam were compared in the treatment of acute convulsions in children to develop a practical and safe treatment protocol . In the diazepam group , the seizures of 13 ( 60 % ) patients terminated in 10 minutes ; however , 9 ( 40 % ) patients did not respond . In the midazolam group , 20 ( 87 % ) patients responded in 10 minutes , but 3 ( 13 % ) patients did not respond . Regarding the anticonvulsant effect , midazolam was found to be more effective than diazepam , and the difference was statistically significant ( P < .05 ) . The necessity of a second drug for the seizures that did not stop with the first drug was higher in the diazepam group than the midazolam group , and the difference was statistically significant ( P < .05 ) . We conclude that as an antiepileptic agent , intranasal midazolam is more effective than rectal diazepam . After administration , we did not observe any serious complications . Further investigations are necessary ; however , intranasal administration is easy , so if the nasal drop and spray forms used in some European countries and the United States are available worldwide , it will be very useful for physicians in the emergency room . ( J Child Neurol 2002;17:123 - 126 ) OBJECTIVE . Our goal was to compare the efficacy and safety of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ug and an children . METHODS . This was a single-blind , r and omized clinical trial in which 330 patients were r and omly assigned to receive buccal midazolam or rectal diazepam . The trial was conducted in the pediatric emergency unit of the national referral hospital of Ug and a. Consecutive patients who were aged 3 months to 12 years and presented while convulsing or who experienced a seizure that lasted > 5 minutes were r and omly assigned to receive buccal midazolam plus rectal placebo or rectal diazepam plus buccal placebo . The primary outcome of this study was cessation of visible seizure activity within 10 minutes without recurrence in the subsequent hour . RESULTS . Treatment failures occurred in 71 ( 43.0 % ) of 165 patients who received rectal diazepam compared with 50 ( 30.3 % ) of 165 patients who received buccal midazolam . Malaria was the most common underlying diagnosis ( 67.3 % ) , although the risk for failure of treatment for malaria-related seizures was similar : 35.8 % for rectal diazepam compared with 31.8 % for buccal midazolam . For children without malaria , buccal midazolam was superior ( 55.9 % vs 26.5 % ) . Respiratory depression occurred uncommonly in both of the treatment arms . CONCLUSION . Buccal midazolam was as safe as and more effective than rectal diazepam for the treatment of seizures in Ug and an children , although benefits were limited to children without malaria Objective : To compare treatment of ongoing seizures using intramuscular ( IM ) midazolam versus intravenous ( IV ) diazepam Design : Controlled clinical trial Patients : Children with motor seizures of at least 10 minutes ' duration Main outcome measures : Time to cessation of seizures Results : Twenty-four patients were enrolled ( 13 midazolam , 11 diazepam ) . Initial treatment with either midazolam or diazepam was successful in 22 of the 24 patients . One patient in each group failed therapy and eventually required endotracheal intubation and general anesthesia for convulsive status epilepticus lasting more than one hour . Patients in the midazolam group received medication sooner ( 3.3 ± 2.0 vs 7.8 ± 3.2 minutes , P=0.001 ) and had more rapid cessation of their seizures ( 7.8 ± 4.1 vs 11.2 ± 3.6 , P=0.047 ) than patients r and omized to receive diazepam Conclusions : IM midazolam is an effective anticonvulsant for children with motor seizures . Compared to IV diazepam , IM midazolam results in more rapid cessation of seizures because of more rapid administration . The IM route of administration may be particularly useful in physicians ' offices , in the prehospital setting , and for children with difficult IV Abstract Objective : To compare the safety and efficacy of midazolam given intranasally with diazepam given intravenously in the treatment of children with prolonged febrile seizures . Design : Prospect i ve r and omised study . Setting : Paediatric emergency department in a general hospital . Subjects : 47 children aged six months to five years with prolonged febrile seizure ( at least 10 minutes ) during a 12 month period . Interventions : Intranasal midazolam ( 0.2 mg/kg ) and intravenous diazepam ( 0.3 mg/kg ) . Main outcome measures : Time from arrival at hospital to starting treatment and cessation of seizures . Results : Intranasal midazolam and intravenous diazepam were equally effective . Overall , 23 of 26 seizures were controlled with midazolam and 24 out of 26 with diazepam . The mean time from arrival at hospital to starting treatment was significantly shorter in the midazolam group ( 3.5 ( SD 1.8 ) minutes , 95 % confidence interval 3.3 to 3.7 ) than the diazepam group ( 5.5 ( 2.0 ) , 5.3 to 5.7 ) . The mean time to control of seizures was significantly sooner ( 6.1 ( 3.6 ) , 6.3 to 6.7 ) in the midazolam group than the diazepam group ( 8.0 ( 0.5 ) , 7.9 to 8.3 ) . No significant side effects were observed in either group . Conclusion : Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam , although midazolam was as safe and effective as diazepam . The overall time to cessation of seizures after arrival at hospital was faster with intranasal midazolam than with intravenous diazepam . The intranasal route can possibly be used not only in medical centres but in general practice and , with appropriate instructions , by families of children with recurrent febrile seizures at home One hundred eighty-eight seizure episodes in 46 children were r and omly assigned to receive treatment with rectal diazepam and intranasal midazolam with doses of 0.3 mg/kg body weight and 0.2 mg/kg body weight , respectively . Efficacy of the drugs was assessed by drug administration time and seizure cessation time . Heart rate , blood pressure , respiratory rate , and oxygen saturation were measured before and after 5 , 10 , and 30 minutes following administration of the drugs in both groups . Mean time from arrival of doctor to drug administration was 68.3 + /- 55.12 seconds in the diazepam group and 50.6 + /- 14.1 seconds in the midazolam group ( P = 0.002 ) . Mean time from drug administration to cessation of seizure was significantly less in the midazolam group than the diazepam group ( P = 0.005 ) . Mean heart rate and blood pressure did not vary significantly between the two drug groups . However , mean respiratory rate and oxygen saturation differed significantly between the two drug groups at 5 , 10 , and 30 minutes after drug administration . Intranasal midazolam is preferable to rectal diazepam in the treatment of acute seizures in children . Its administration is easy , it has rapid onset of action , has no significant effect on respiration and oxygen saturation , and is socially acceptable Objective : To determine effectiveness of intramuscular midazolam to control  acute seizures in children as compared to intravenous diazepam . Methods : 115 children in the age group of 1 month to 12 years who presented with acute convulsions were enrolled in the study . Patients who already had an intravenous access present were treated intravenous diazepam .  Patients without an IV access at the time of convulsions were r and omised into 2 groups and treated with either intramuscular midazolam or intravenous diazepam for control of seizures . Time interval from administration of drug to cessation of seizures was compared . Effectiveness of IM midazolam in various age groups , types of convulsions and etiology of convulsions was analyzed . Side effects of both drugs were evaluated . Results : the mean interval to c 
    Output:
    
Non-IV midazolam , compared to non-IV or IV diazepam , is safe and effective in treating SE .