Background: Seizures are one of the commonest neurological problem in Children. Diazepam is one of the most frequently used benzodiazepines both intravenously as well as rectally. Midazolam has 3-4 times better potency than diazepam and can be given IV, rectal or intramuscular. The effectiveness and easier route of these drugs administration are important choice to make faster seizure cessation.

Objective: To determine the effectiveness of intramuscular midazolam compared to rectal diazepam for terminating seizures in children.

Methods: The subjects were children with age from 1 month to 18 years who presenting with acute seizures. Patients were randomised into 2 groups with either received intramuscular midazolam or rectal diazepam for terminating seizures. Time interval from drug administration to cessation of seizures was compared. Log rank analysis was used for statistical analysis. Side effect of both drugs were evaluated.

Results: There were 66 patients, 33 in each groups enrolled the study. The median time interval for seizures cessation with intramuscular midazolam was 45 seconds, otherwise in rectal diazepam group was 180 seconds. There was statistically significant difference time interval between two groups (p<0.01). Intramuscular midazolam worked faster in patients with febrile convulsions, epilepsy and encephalitis. Five patients had time cessation of seizure more than 5 minutes. None of the both groups had any side effects which was statistically significant.

Conclusion: Intramuscular midazolam is effective for terminating seizures in children. It can be used as an alternative treatment for acute seizures in patients with intravenous or rectal route difficulties.