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Refractory Status Epilepticus — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersRefractory Status EpilepticusSCE Neurology

A 40-year-old woman presents with refractory convulsive status epilepticus. She has received two doses of intravenous lorazepam and a loading dose of intravenous phenytoin, but seizures persist after 45 minutes. What is the next most appropriate step?

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Correct answer: C — Transfer to intensive care for general anaesthesia with propofol or midazolam infusion

Refractory status epilepticus is defined as seizures persisting despite two appropriately dosed stages of treatment. After failure of first-line benzodiazepines and second-line agents (phenytoin, levetiracetam, or valproate), the patient should be transferred to intensive care for general anaesthesia, typically with propofol or midazolam infusion and continuous EEG monitoring. A: Repeating benzodiazepines beyond the protocol risks respiratory depression without efficacy. B: Valproate could have been used as an alternative second-line agent, but the clinical priority now is anaesthesia. D: IM midazolam is a first-line community option, not appropriate at this stage. E: Oral clobazam has no role in acute refractory SE.

Reference: NICE NG217 (2025); ABN Status Epilepticus Guidelines