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Status Epilepticus — RACP Paediatrics MCQ

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HardEmergency PaediatricsStatus EpilepticusRACP Paediatrics

A 7-year-old with genetically confirmed Dravet syndrome remains in convulsive status after two adequate benzodiazepine doses. IV access, ECG monitoring and resuscitation support are established. Which second-line medicine is the best choice?

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

Reveal the answer and explanation

Correct answer: E — Give levetiracetam 60 mg/kg IV over 5 minutes while preparing refractory-status support

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

A is correct. After two adequate benzodiazepine doses, RCH lists levetiracetam 40–60 mg/kg IV/IO over five minutes as a second-line option. B is contraindicated here because sodium-channel blockade with phenytoin can aggravate seizures in Dravet syndrome. C exceeds the recommended benzodiazepine sequence and increases respiratory depression. D reserves pyridoxine for refractory seizures in children up to six months, not a seven-year-old. E is an anaesthetic strategy for refractory status after appropriate second-line treatment, not before it. Critical-care help and preparation for refractory-status anaesthesia proceed if levetiracetam fails.

Reference: Royal Children’s Hospital Melbourne: Seizures—acute management: https://www.rch.org.au/afebrile_seizures/