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      Sleep Inducing for EEG Recording in Children: A Comparison between Oral Midazolam and Chloral Hydrate

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          Abstract

          Objective

          Electroencephalography (EEG) recording is a long duration procedure that needs patient’s cooperation for device setup and performing the procedure. Many children lose their cooperation during this procedure.

          Therefore, sedation and sleep are frequently induced using a few agents as pre procedure medication in children before EEG recording. We aimed to compare the sedative effects of oral midazolam versus chloral hydrate before the procedure along with their impacts on EEG recording in children.

          Materials & Methods

          A randomized trial was carried out to compare the sedative effects of oral midazolam versus chloral hydrate and their impacts on EEG recording in children. A total of 198 children (100 in the midazolam group and 98 in the chloral hydrate group) were enrolled in the study and randomly allocated to receive either oral moidazolam or chloral hydrate.

          Results

          Oral midazolam had superiority neither in sleep onset latency nor in sleep duration when compared to chloral hydrate. Moreover, the yield of epileptiform discharges in the chloral hydrate group was more than the midazolam group.

          Conclusion

          The results of this study showed that both chloral hydrate 5% (one ml/kg) and oral midazolam (0.5 mg/kg) could be administered as a pre medication agent for EEG recording in children. However, oral midazolam at this dose had no advantage compared with chloral hydrate.

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          Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics.

          B. Neville, Ethan K. Scott, Eric Boyd … (1998)
          To determine whether buccal/sublingual administration of midazolam (MDL) would lead to detectable venous concentrations and EEG changes in 10 healthy volunteers. The study consisted of an open-label and a double-blind phases. Subjects held 10 mg MDL in 2 ml peppermint-flavored fluid or peppermint-flavored placebo in their mouth for 5 min and then spat it out. Cardiorespiratory and EEG monitoring was performed in all subjects. Venous MDL concentrations measured on 10 occasions from 5 to 600 min after administration showed a rapid increase for the first 20-30 min. However, changes in the 8- to 30-Hz frequencies identified by spectral analysis of the EEG showed changes in < or = 5-10 min in test but not in control subjects--more rapid than were expected from the venous absorption data. There were no significant adverse effects. Our data provide direct evidence of the speed of cerebral effect of a drug. Our results suggest that the buccal/sublingual route of administration should be tested in emergency treatment of seizures as an alternative to the rectal route, over which it has clear practical advantages.
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            Melatonin versus chloral hydrate for recording sleep EEG.

            Mahmoud Reza ASHRAFI, Mahmoud Mohammadi, Javad Tafarroji … (2010)
            Although behavioral training could be successful in promoting electroencephalogram (EEG) compliance without restraint or sedation, sleep EEG may increase the yield of seizure activity. Furthermore uncooperative children not amenable to behavioral training require sedation for EEG recording. Our aim was to assess the impact of melatonin on the sleep EEG recording in comparison with chloral hydrate. Three hundred and forty eight patients (aged 1 month to 6 years) that were uncooperative with the EEG setup or referred for sleep EEG were enrolled in the study. Patients, partially sleep-deprived the night before, were randomly divided in two groups of melatonin and chloral hydrate on an alternative day basis, 174 patients in each group. Sleep onset latency in the chloral hydrate and melatonin groups was similar (Mann-Whitney test, P=0.113). However, sleep duration and drowsiness time were significantly shorter in the group of melatonin compared to the group of chloral hydrate (Mann-Whitney test, P<0.0001 and P<0.0001 respectively). More patients in the melatonin group (20 versus six patients in the chloral hydrate group) required a second dose of sedative for sleep induction (chi square test, P value=0.004). Seizure activities appeared in the electroencephalograms of 53% and 46% of patients in the melatonin and chloral hydrate groups respectively that were significantly higher in the melatonin group (chi square test, P=0.005). Few adverse effects occurred in both groups (Fisher's exact test, P=0.64). The shorter sleep duration and drowsiness period were the two advantages of melatonin over chloral hydrate. Furthermore higher yield of seizure activity detection in melatonin sedated patients was in favor of its prescription for sleep EEG recording in the pediatric population. Copyright 2009 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
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              Does a sedative dose of chloral hydrate modify the EEG of children with epilepsy?

              Marianne Thoresen, Olaf Henriksen, Ebba Wannag … (1997)
              Chloral hydrate (CH) is used to sedate children unable to cooperate during investigations such as EEG requiring the patient to be still. It is not known if CH or its metabolites modify the EEG and our aim was to answer this question. Recordings of the EEG before, during and after rectal administration of CH (50-77 mg/kg) in 13 children aged 1.5-13.5 years with severe epilepsy and additional neurological impairments were made. All children had frequent spike-wave activity before CH. In 9 children CH had no effect on the EEG. In 3 children there was a significant reduction in epileptic activity after 20-50 min and in one a significant increase. Cardiovascular parameters were stable throughout. At sedative doses, CH can generally be used before an EEG recording without loss of information but in 4 out of 13 children there were changes which could alter interpretation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Child Neurol
                Journal ID (iso-abbrev): Iran J Child Neurol
                Journal ID (publisher-id): IJCN
                Title: Iranian Journal of Child Neurology
                Publisher: Shahid Beheshti University of Medical Sciences (Tehran, Iran )
                ISSN (Print): 1735-4668
                ISSN (Electronic): 2008-0700
                Publication date (Print): Winter 2013
                Volume: 7
                Issue: 1
                Pages: 15-19
                Affiliations
                [1 ]Professor of Pediatric Neurology, Pediatrics Centre of Excellence, Department of Pediatric Neurology, Children’s Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Assistant Professor of Pediatric Neurology, Department of Pediatric Neurology, Golestan Medical, Educational, and Research Centre, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
                [3 ]3.Associate Professor of Pediatric Neurology, Pediatrics Centre of Excellence, Department of Pediatric Neurology, Children’s Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
                [4 ]Assistant Professor of Pediatric Neurology, Department of Pediatric Neurology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
                Author notes
                Corresponding Author: Hosseini F. MD Paediatrics Centre of Excellence, Department of Paediatric Neurology, Children’s Medical Centre, Tehran University of Medical Sciences, # 62, Gharib Street, P.O. Box 1419733151, Tehran, Iran Tel/Fax: +98 21 66935848 Email address: firozeh_hosseini@ 123456yahoo.com
                Article
                Publisher ID: ijcn-7-015
                PMC ID: 3943082
                PubMed ID: 24665284
                SO-VID: c3db78ea-faf8-4b55-b8bb-5e061e7b2162
                Copyright © © 2013: Iranian Journal of Child Neurology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 September 2012
                Date revision received : 20 October 2012
                Date accepted : 23 October 2012
                Categories
                Subject: Original Article

                Keywords: chloral hydrate,oral midazolam,sleep,sedation,electroencephalography,children
                Data availability:
                Keywords: chloral hydrate, oral midazolam, sleep, sedation, electroencephalography, children

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