Intramuscular midazolam versus intravenous clonazepam for prehospital treatment of generalized tonic-clonic seizures: A randomized double-blind non-inferiority trial.

Baseline characteristics were comparable.

Treatment success was 75% with intramuscular midazolam versus 62.5% with intravenous clonazepam (risk difference, +12.5 percentage points; 95% CI, -10.0 to +33.4), confirming non-inferiority because the lower confidence limit remained above the prespecified margin of -15 percentage points.

No significant differences were observed in adverse events or 48-hour outcomes, including endotracheal intubation (6%vs 9%; p = 0.74).