Intramuscular midazolam versus intravenous clonazepam for prehospital treatment of generalized tonic-clonic seizures: A randomized double-blind non-inferiority trial.
SeizureAug 10, 2026 (epub)
Hela Manai, Sarra Akari, Teycir Kharraz et al.
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In 30 seconds
This randomized double-blind non-inferiority trial evaluated the efficacy of intramuscular (IM) midazolam versus intravenous (IV) clonazepam for prehospital treatment of generalized tonic-clonic seizures in patients aged ≥14 years. The study found that IM midazolam achieved a treatment success rate of 75% compared to 62.5% for IV clonazepam, confirming non-inferiority with a risk difference of +12.5 percentage points.
Key findings
- IM midazolam had a treatment success rate of 75% compared to 62.5% for IV clonazepam.
- The time to complete seizure cessation was significantly shorter for IM midazolam at 1:42 minutes versus 3:13 minutes for IV clonazepam.
- No significant differences in adverse events were observed between the two treatments.
Why it matters
The findings suggest that IM midazolam is an effective alternative to IV clonazepam for managing generalized tonic-clonic seizures in prehospital settings, potentially reducing delays in treatment due to IV access challenges.