Non-Convulsive Status Epilepticus — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardEpilepsy & Seizure DisordersNon-Convulsive Status EpilepticusSCE Neurology

A 45-year-old remains in generalised convulsive status epilepticus after two correctly dosed intravenous lorazepam administrations 8 minutes apart. He has severe chronic liver disease, systolic blood pressure 88 mmHg and a history of complete heart block. Which intravenous antiseizure medicine is the best next choice?

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

Reveal the answer and explanation

Correct answer: A — Levetiracetam

After two benzodiazepine doses fail, NICE lists intravenous levetiracetam, phenytoin or sodium valproate as second-line treatment and notes that levetiracetam may be quicker to administer and have fewer adverse effects. Severe liver disease makes valproate an unattractive choice, while hypotension and complete heart block increase the hazards of phenytoin. Levetiracetam is therefore the best of the three listed second-line options in this patient. Phenobarbital is a third-line consideration after second-line treatment fails, and another lorazepam dose would extend the initial benzodiazepine sequence while adding respiratory and haemodynamic risk.

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