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Stroke & neuro
IM midazolam non-inferior for prehospital seizures
Intramuscular midazolam versus intravenous clonazepam for prehospital treatment of generalized tonic-clonic seizures: A randomized double-blind non-inferiority trial
Seizure: European Journal of Epilepsy · Added 27 August 2026
Randomised double-blind non-inferiority trial testing whether IM midazolam is non-inferior to IV clonazepam for prehospital seizures — it was, with 75% treatment success for IM midazolam versus 62.5% for IV clonazepam (risk difference +12.5 percentage points; 95% CI -10.0 to +33.4).
- Study type
- RCT
- Design
- Randomised double-blind non-inferiority trial (physician-staffed EMS, Tunis)
- Participants
- 64 patients aged ≥14 with witnessed tonic-clonic seizures ≥5 min (32 per group)
- Main finding
- Treatment success 75% IM midazolam vs 62.5% IV clonazepam (risk difference +12.5 pp; 95% CI -10.0 to +33.4), meeting non-inferiority; time to seizure cessation shorter with IM midazolam (1:42 vs 3:13 min)
- Caveat
- Small sample; wide confidence interval; physician-staffed Tunisian system may not generalise
- Bottom line
- Hypothesis-generating
Why it matters in Australia (High relevance). Directly relevant to prehospital seizure management — IM midazolam is widely used in Australia and this RCT supports its use when IV access would delay treatment.
Learning goal
Weigh intramuscular midazolam against intravenous benzodiazepines for prehospital seizure control in my practice.
More
- Topic: Stroke & neuro
- Daily scan: 27 August 2026
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