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Status epilepticus – initial treatment — MRCEM SBA MCQ

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HardNeurologyStatus epilepticus – initial treatmentMRCEM SBAMRCP Part 1UKMLAPARA

A 68-year-old in hospital has generalised convulsive activity lasting six minutes. Airway support, oxygen, glucose measurement and intravenous access are immediately available; there is no individual emergency plan. Which first drug treatment is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Intravenous lorazepam as the first benzodiazepine dose

B is correct. NICE defines convulsive status epilepticus as seizure activity lasting five minutes or more. With immediate IV access and resuscitation facilities, intravenous lorazepam is first-line. Levetiracetam and phenytoin are second-line choices after two adequate benzodiazepine doses fail. Intramuscular diazepam is not the preferred route here and an oral drug is too slow and unsafe during ongoing convulsions.

Reference: NICE NG217 status epilepticus recommendations: https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures