A systematic review of the use of buccal midazolam in the emergency treatment of prolonged seizures in adults with learning disabilities

Accessible summary• People with a learning disability can have epilepsy and can have long seizures. • The treatment for long seizures is rectal diazepam given up the back passage. • Some carers and people with epilepsy do not like this. • Buccal midazolam is a treatment for long seizures that is given by mouth. • Buccal midazolam seems to work as well as rectal diazepam in children with epilepsy. • New guidance to doctors says they can use buccal midazolam in adults for long seizures. • People with learning disabilities and carers can ask their doctor to prescribe buccal midazolam instead of rectal diazepam to treat long seizures.Abstract Background  Buccal midazolam is widely used in children for the emergency treatment of epilepsy, and these children are graduating into adult learning disability services. Aims  The aim of this paper was to appraise the evidence for buccal midazolam as a treatment for prolonged seizures in adults with learning disabilities. Method  A literature search was performed and the identified papers appraised. Results  The literature search identified only one randomized trial for buccal midazolam as emergency treatment of seizures, and this was in children and adolescents. It showed that buccal midazolam was as effective as rectal diazepam. Conclusions  There is evidence that buccal midazolam is effective, but it is unlicensed for this purpose. Rectal diazepam should remain the first choice, but buccal midazolam should be discussed with patients and carers as an alternative. Declaration of interest  nil.