Acute Seizure Management — FRCA Final MCQ

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EasyMedicolegal & EthicsAcute Seizure ManagementFRCA Final

A 58-year-old man with known epilepsy develops a generalised tonic–clonic seizure during a procedure in a hospital dental suite. The seizure continues for 5 minutes. He has no individualised emergency management plan immediately available. A patent intravenous cannula and full resuscitation facilities are immediately available. According to NICE, which is the first-line pharmacological treatment?

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Correct answer: E — Intravenous lorazepam

The correct answer is E, intravenous lorazepam. A generalised convulsive seizure lasting at least 5 minutes is convulsive status epilepticus. NICE recommends intravenous lorazepam when no individualised emergency plan is immediately available and both intravenous access and resuscitation facilities are immediately available. Buccal midazolam and rectal diazepam are first-line options in the community, where intravenous access is usually unavailable; buccal midazolam is generally preferred between these routes. Intravenous diazepam is not NICE's specified first-choice intravenous treatment in this setting. Intravenous phenytoin is a second-line antiseizure medicine and should be considered only if status epilepticus persists after two appropriately administered benzodiazepine doses. Airway, breathing, circulation and reversible causes such as hypoglycaemia must be addressed concurrently.

Reference: NICE guideline NG217, Epilepsies in children, young people and adults, section 7.1: Initial treatment for generalised convulsive status epilepticus, updated 2025. https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures