Status Epilepticus — RACP Adult Medicine MCQ

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

ModerateNeurologyStatus EpilepticusRACP Adult Medicine

A 42-year-old man presents to the emergency department with status epilepticus. He has been seizing for 15 minutes. He has received two doses of IV midazolam with no response. What is the next appropriate antiepileptic drug?

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

Reveal the answer and explanation

Correct answer: E — Levetiracetam IV

After failure of benzodiazepines in status epilepticus, second-line IV antiepileptic agents include levetiracetam, sodium valproate, or phenytoin/fosphenytoin. Recent evidence (ConSEPT and EcLiPSE trials, and ESETT trial) suggests levetiracetam and sodium valproate are reasonable first-line alternatives to phenytoin with fewer adverse effects. In Australian practice, levetiracetam is increasingly used as the preferred second-line agent due to its favourable safety profile and ease of administration.

Reference: eTG – 2025 – Neurology; AES – 2024 – Status Epilepticus Guidelines