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Established SE – Second-Line — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEstablished SE – Second-LineSCE Neurology

A 43-year-old remains in convulsive status after two lorazepam doses. He has acute hepatic failure, PR interval 240 ms and a previous severe rash with aromatic antiseizure medicines. Which intravenous second-line drug is the best fit?

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Correct answer: C — Use levetiracetam with renal and behavioural surveillance

Levetiracetam is one of NICE’s second-line options and avoids the major hepatic toxicity of valproate, infusion-related conduction risk and aromatic-drug rash concerns of phenytoin, and PR-prolonging concern with lacosamide. Phenobarbital is generally considered after initial second-line failure and adds respiratory depression and hepatic metabolism. Renal function still guides levetiracetam dosing.

Reference: NICE NG217 treating status epilepticus and repeated or cluster seizures (Updated January 2025): https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures