Essay Example on Is Midazolam effective for treating Status Epilepticus?

Epilepsy and its treatment have a long history in the western world, dating back at least 4 millennia to the ancient Middle Eastern civilization. Treatments in the past and present have been empirical, reflecting the prevalent epilepsy views, whether medical, theological, or superstitious. Status epilepticus was first recognized in antiquity and was mentioned on a Babylonian clay tablet dating from 600–700 B.C. (Shorvon, 1994). Until the 19th century, however, the existence of extended seizures was mostly ignored, or at least not written about.

Status Epilepticus is a condition when an individual experiences a couple of seizures in a span of a short time period. Between seizures, the individual is unable to regain a normal/ average level of consciousness. This condition is commonly experienced by the elderly or children. Status Epilepticus is mainly caused due to head injuries along with central nervous system infection such as traumatic brain injury (TBI), intracranial abscess, and many more. For light causes, Status Epilepticus can be caught from drug toxicity by drinking alcohol too much, low blood sugar or abnormal sodium, and fever. Based on the statistic created by MDPI, it is shown that Status Epilepticus can result in incidence or in-hospital mortality. As the decade of life goes on, the percentage of in-hospital mortality with Status Epilepticus has a major growth, from below 5% to 20%. The same goes for people who experience the incidence of Status Epilepticus, as the decade of life elapse, there have been changes from 15 per 10,000 down to 5 per 10,000 and rises back up to approximately 25-30 per 10,000.

Treating Status Epilepticus can be exceedingly simple or complex. Either way, Midazolam is presently the first-line treatment for status epilepticus in quite a while. Midazolam is classified as a benzodiazepine medication and it is used for anesthetic. Based on figure 1(1,4-Benzodiazepines and New Derivatives: Description, Analysis, and Organic Synthesis), the structural class of substances known as benzodiazepines includes hypnotics, anxiolytics, anticonvulsants, and muscle relaxants. A benzene ring and a diazepine ring are fused together to form their chemical structure. In positions 1, 2, 5, and 7, distinct compounds have different side groups connected to the core structure. The varied side groups regulate the pharmacological qualities, the potency of the effect, and the pharmacokinetic conditions via affecting the molecule's binding to the GABAA receptor (duration of the effect, distribution, etc.). Meanwhile, based on figure 2 (Midazolam), Midazolam is a short-acting imidazole-structured benzodiazepine derivative with anxiolytic, amnestic, hypnotic, anticonvulsant, and sedative effects.

The purpose of using Midazolam is to overcome current seizures and prevent longer complications of epilepsy. When Midazolam is injected the patient’s brain will slowly go into relaxation which allows the consciousness to decrease. Midazolam's exact mechanism of action in the brain is uncertain. It appears to work by altering the way gamma-aminobutyric acid (GABA) functions in the brain to suppress or halt seizures. In the brain, GABA is a significant chemical or neurotransmitter. Based on the information given by Lubarsky, sedative effects are generated when consuming Midazolam. This is because when Midazolam is consumed, it enables the binding of a brain chemical called GABA to brain receptors, which prevents the flow of electrical impulses in the brain.

Midazolam is a clear, colorless to a pale yellow solution with a pH in the range of 2.9 - 3.7 and 270 mOsm/kg to 330 mOsm/kg osmolality. For the dosage of use, Midazolam is different for different age range. For adults below the age of 60 (from 16 above) the first dose of Midazolam used is around 2 to 2.5 mg which will be given 5 to 10 minutes before the procedure. If necessary, 1 mg more dose may be given afterward. For pediatric patients 6 months to 5 years of age, the first dose is 0.05 to 0.1 mg/kg. For pediatric patients from 6 to 12 years of age, the first dose is 0.025 to 0.05 mg/kg. If necessary, 0.4 mg/kg to a maximum of 10 mg may be given after the first dose. 

Midazolam is a benzodiazepine that dissolves in water in which can be given through many different routes such as,  intramuscularly (injected through muscle), intravenously(entering through the vein),  or transmucosal(from the mouth). Giving midazolam by infusion into a vein (intravenously) may cause serious breathing issues which could seldom prompt cerebrum harm. The danger of genuine breathing issues is higher with high dosages or on the other hand in case midazolam is given excessively fast into a vein. Therefore, Midazolam should always be utilized under close clinical management. 

The appearance of Midazolam has been very beneficial to the community.  Midazolam is known for being the lowest anesthesia medical drug in terms of cost/price. In pharmacy’s Midazolam is sold for approximately $20 dollars or less. It is absolutely cheap and affordable compared to other anesthetics, therefore it is easy to reach, access, and socially acceptable to all. Although is cheap, the quality and benefits of Midazolam are still first-rate and safe to consume. 

In conclusion, Midazolam is an anesthesia medical drug that is used to sedate patients who are experiencing a certain seizure such as Status Epilepticus. Midazolam has been proven to be the leading and top medicine to cure Status Epilepticus. Status Epilepticus is a condition where an individual experiences multiple seizures (complications) in a span of 5-10 minutes. When experiencing seizures, patients are given Midazolam to lighten the effects and end the seizure quicker. The process of Midazolam in the body is fast therefore patients do not experience much pain. In addition to is, Midazolam is exceedingly affordable for all, therefore is socially preferable. 

Work Cited

“Midazolam”.National Center for Biotechnology Information. PubChem Compound Database, U.S. National Library of Medicine. https://pubchem.ncbi.nlm.nih.gov/compound/Midazolam#:~:text=Midazolam%20is%20a%20short%2Dacting,hypnotic%2C%20anticonvulsant%20and%20sedative%20properties. 

“Midazolam nasal”. Epilepsy Foundation. https://www.epilepsy.com/medications/midazolam-nasal#:~:text=How%20does%20Midazolam%20Nasal%20affect,or%20neurotransmitter%20in%20the%20brain. 

“Midazolam for Stopping seizures: Medicines for children”. Midazolam for stopping seizures | Medicines for Children. https://www.medicinesforchildren.org.uk/midazolam-stopping-seizures 

“Midazolam uses, side effects & warnings”.Drugs.com. https://www.drugs.com/mtm/midazolam.html 

Batlle, Elisabet, et al. “1,4-Benzodiazepines and New Derivatives: Description, Analysis, and Organic Synthesis.” IntechOpen, IntechOpen, 5 Nov. 2018, www.intechopen.com/chapters/63768