The use of intramuscular midazolam for acute seizure cessation or behavioral emergencies in patients with traumatic brain injury.

Brain-injured patients involved in rehabilitation programs are susceptible to the occurrence of acute seizures or severe behavioral episodes. Effective pharmacological management in this setting should ideally include rapid onset without severe adverse effects. Previous treatments have generally included intramuscular diazepam or lorazepam, as well as intramuscular antipsychotic drugs. These options have proved problematic due to poor absorption, slow onset of activity, or potential for unacceptable side effects. We report 10 cases involving the use of intramuscular midazolam, a rapid-acting, short half-life benzodiazepine, in treating acute seizures or behavioral problems. We conclude that this drug demonstrates great promise for the rapid, effective treatment of these conditions without significant adverse effects and deserves further study in these areas.