OBJECTIVE: To compare the efficacy of midazolam and diazepam for treatment of acute seizures in children. METHODS: One hundred and twenty children with acute seizures were randomly divided into two groups: midazolam (0.1-0.3 mg/kg) and diazepam treatment (0.3-0.5 mg/kg) (n=60 each). In cases with seizure recurrence or statural convulsivus, a maintenance dose of midazolam (1-8 mg/kg per hour) and a maintenance dose of diazepam (0.5-1 mg/kg per hour) or along with phenobarbital sodium were given in the midazolam and diazepam treatment groups, respectively. The therapeutic effects were compared between the two groups. RESULTS: The seizures were relieved in all cases from the two groups 10 minutes after administration of midazolam or diazepam. There were no significant differences in the average time of seizure control between the two groups. Five children in the midazolam group had seizure recurrence or statural convulsivus after 10 minutes compared with 13 children in the diazepan group (P<0.05). The time of seizure control averaged 40±32 minutes in the midazolam group compared with 69±24 minutes in the diazepam group after maintenance treatment (P<0.05). No midazolam and diazepam treatment related adverse events were observed. CONCLUSIONS: Midazolam is safe and effective in the treatment of acute seizures in children. Midazolam appears to be a better option in the treatment of recurrent seizures or statural convulsivus than diazepam.［Chin J Contemp Pediatr, 2010, 12 (7):530-532］