Status Epilepticus Buccal Midazolam — ORE Part 1 MCQ

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EasyPharmacology & TherapeuticsStatus Epilepticus Buccal MidazolamORE Part 1

An adult with known epilepsy has a generalised tonic-clonic seizure in the dental chair. It continues for 6 minutes despite appropriate first aid, including protection from injury and timing. No individual emergency management plan is available. Which drug should be administered now?

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Correct answer: B — Buccal midazolam 10 mg

The correct answer is B. A convulsive seizure lasting 5 minutes or more requires immediate emergency treatment. In the community setting, including a dental practice, NICE recommends a benzodiazepine; buccal midazolam is the preferred option, and 10 mg is the adult dose. It is administered into the buccal sulcus between the gum and cheek. Rectal diazepam is also a NICE first-line community option, but is an alternative where buccal midazolam is unavailable or has been individually agreed, so it is not the single best answer. Intravenous treatment would be intravenous lorazepam, not diazepam, and only where IV access and resuscitation facilities are immediately available. Adrenaline treats anaphylaxis. Oral carbamazepine is maintenance antiseizure therapy and must not be given during an active seizure.

Reference: National Institute for Health and Care Excellence. Epilepsies in children, young people and adults (NG217), section 7: Treating status epilepticus, repeated or cluster seizures, and prolonged seizures. Updated 30 January 2025. https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures