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Buccal Midazolam – Community Rescue — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersBuccal Midazolam – Community RescueSCE Neurology

A 55-year-old man with known epilepsy presents with a cluster of seizures — 3 focal to bilateral tonic-clonic seizures within 24 hours, with full recovery of consciousness between each seizure. He does not meet the criteria for status epilepticus. His neurologist prescribes an emergency rescue medication for the family to administer at home if seizures cluster again. What is the recommended rescue medication?

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Correct answer: B — Buccal midazolam — administered into the buccal cavity by trained family/carers for seizure clusters or prolonged seizures (>5 minutes) in the community

Buccal midazolam is the recommended community rescue medication for prolonged seizures (>5 minutes) or seizure clusters. It is administered into the buccal space (between the cheek and gum) by trained family members, carers, or paramedics. It has similar efficacy to rectal diazepam but is more socially acceptable and easier to administer. NICE NG217 recommends that patients at risk of prolonged seizures or clusters should have a personalised emergency medication plan including buccal midazolam. A: Oral phenytoin is too slow. C: IV lorazepam requires IV access. D: Oral CBZ is not a rescue medication. E: Paracetamol has no anticonvulsant effect.

Reference: NICE NG217 (2025); BNF – Buccal Midazolam