Study Highlights: To compare the efficacy of high-dose and conventional low-dose midazolam in the treatment of refractory epilepsy. The high-dose group had lower seizure rates and mortality in patients than the traditional low-dose group. Midazolam is a commonly used drug for refractory epilepsy. For patients with large refractory epilepsy, complete control was achieved within an average of 45 min without significant changes in blood pressure, heart rhythm, or respiratory depression, and complete recovery of consciousness was achieved an average of 1.6 h after discontinuation of the drug. midazolam is safe and efficacious. Under the current mainstream of evidence-based medicine, what is the optimal regimen for patients becomes increasingly important. To address this situation, Dr. Andres Fernandez et al. from the Department of Neurology, Columbia University Medical Center, New York, USA, conducted a study with the aim of comparing two groups of high and low dose continuous intravenous midazolam (cIV-MDZ) infusion for the treatment of refractory persistent epilepsy in order to facilitate the best decision making for patients. The results of the study, published online in the December 20, 2013 issue of Neurology, show that high-dose continuous intravenous midazolam infusion for refractory status epilepticus proved to be safe and resulted in lower seizure rates and patient mortality than traditional low-dose regimens. The study was conducted in adults treated for refractory status epilepticus and compared the difference between the high-dose continuous intravenous midazolam group ((n = 100; 2002C2011) and the group that had been treated with a lower dose of continuous intravenous midazolam (n = 29; 1996C2000). seizure control, hospitalization, and clinical prognosis. The mean maximum continuous intravenous midazolam dose was 0.4 mg/kg/h in the high-dose group (interquartile range 0.2,1.0) and 0.2 mg/kg/h in the low-dose group (interquartile range 0.1,0.3. p < 0.001), the duration of intravenous infusion was the same in both groups, and the median time between seizure onset and initiation of continuous intravenous midazolam in the high-dose group was 1 days (interquartile difference 1,3) and 2 days in the low-dose group (interquartile difference 1,5. p = 0.016). "Seizure withdrawal" occurred within 48 hours of discontinuation of continuous intravenous midazolam and was least frequent in the high-dose group (15% vs. 64%, advantage ratio 0.1). There was no difference in "final failure of continuous intravenous midazolam" (patients requesting a different continuous intravenous antiepileptic drug) and hospital complications between the two groups. Patients in the high-dose group experienced more hypotension, but it was not associated with a poor prognosis. Discharge mortality was lowest in the high-dose group compared with the low-dose group (40% vs 62%) The study concluded that high-dose continuous intravenous midazolam infusion for refractory status epilepticus proved to be safe, with a low seizure rate and lower patient mortality than conventional low-dose regimens.