Intranasal Versus Intramuscular Midazolam in Pediatric Seizure Control: A Systematic Review and Meta-Analysis

OBJECTIVES: Rapid termination of pediatric seizures is a critical determinant of neurological outcomes. Benzodiazepines are the established first-line therapy, yet intravenous (IV) access is frequently unavailable at initial presentation, necessitating reliance on non-IV routes. However, the optimal non-IV route remains controversial. We aimed to perform a meta-analysis comparing intranasal (IN) and intramuscular (IM) midazolam administration to determine which route is associated with more rapid and reliable seizure control in pediatric patients. METHODS: statistic. Subgroup analyses were performed by administration setting and benzodiazepine dose. The prospective protocol was registered with PROSPERO (CRD420251237948). RESULTS: = 0%). CONCLUSIONS: Among pediatric patients with acute seizures managed in settings where IV access is not established, particularly the prehospital environment, IM midazolam was associated with more rapid seizure termination and lower rescue therapy use than IN midazolam and represents a reasonable first-line option in these settings.