Continuous rate infusion of midazolam as emergent treatment for seizures in dogs

BACKGROUND: Midazolam delivered by continuous rate infusion (CRI) might be effective in dogs with cluster seizures (CS) or status epilepticus (SE). OBJECTIVE: To describe the use and safety of midazolam CRI in dogs with CS or SE. ANIMALS: One‐hundred six client‐owned dogs presenting to a veterinary teaching hospital with CS or SE. METHODS: Retrospective review of medical records for dogs with CS or SE treated with a midazolam CRI. RESULTS: Seventy‐nine dogs presented with CS and 27 dogs had SE. Seizure control was achieved in 82/106 dogs (77.4%) receiving a midazolam CRI. The median dose associated with seizure control was 0.3 mg/kg/h (range, 0.1‐2.5 mg/kg/h). The median duration of CRI was 25 hours (range, 2‐96 hours). Seizures were controlled in 34/40 dogs (85%) with idiopathic epilepsy, 32/43 dogs (74%) with structural epilepsy, 12/16 dogs (75%) with unknown epilepsy, and 4/7 dogs (57%) with reactive seizures (P = .20). Seizure control was achieved in 81% of dogs with CS and 67% in dogs with SE (P = .18). Dogs with idiopathic/unknown epilepsy were more likely to survive than those with structural epilepsy (87% vs 63%, P = .009). Adverse effects were reported in 24 dogs (22.6%) and were mild in all cases. CONCLUSIONS AND CLINICAL IMPORTANCE: Midazolam CRI is apparently safe and might be an effective treatment in dogs with CS or SE.