Background:Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Aim:Compare the safety and efficacy of intranasal midazolam and rectal diazepam until intravenous access is established. Subjects and Methods: this was a randomized controlled clinical trial conducted at the emergency department of the Suez Health Insurance hospital including infants and children ranging between 6 months and 18 years, suffering from acute seizure episodes. Patients were classified into 2 groups: Group (I): 18 patients received intranasal midazolam. Group (II): 18 patients received rectal diazepam. The duration of the study ranged from 6-12 months. Results: Seizures ceased within 11.2 minutes of drug administration in group (I) with SD +/- 2.3 while in group (II) 14 Seizures ceased within 11.4 minutes of drug administration with SD +/- 2.7. There were no statistically significant differences between groups where P=0844. Complications in group (I) show that all patients didn't have any complications while in group (II) (11.1%) had vomiting side effect, 1(5.6%) had hypoxia and 1(5.6%) had Excessive drowsiness. Conclusions: There was no detectable difference in efficacy between intranasal midazolam and rectal diazepam as a rescue medication for the cessation of acute seizures at home.