The use of midazolam as an anticonvulsant: Unexpected outcomes

Between 1992 and 1994, 5 patients with Astrocytomas in whom there was progressive loss of functioning, were admitted to the Palliative Care Unit. Their condition on arrival ranged from semi-comatose to reasonably alert. All had significantly deteriorated from their normal level of functioning and all were on a combination of Dexamethasone and Phenytoin.

The first patient was semi-comatose and had difficulty in swallowing. Midazolam was used via a syringe driver as an anti-convulsant during the terminal phase of her illness. Her conscious level improved. Attempts at reintroducing oral anti-convulsants resulted in loss of function and she was maintained on Midazolam till she died.

Subsequently, 4 other patients with Astrocytomas who had deteriorated and required admission were trialled on Midazolam as an anti-convulsant. All experienced an improvement in their level of functioning. Our experience with the use of Midazolam in the management of increased intracranial pressure for tumours other than Astrocytomas has not resulted in similar improvement.

This paper outlines our experience and attempts to develop an hypothesis as to why this unexpected outcome may occur.