Established status epilepticus — RACP Paediatrics MCQ

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ModerateNeurologyEstablished status epilepticusRACP Paediatrics

A 5-year-old has been seizing for 15 minutes. Two doses of midazolam (buccal then IV) have been given without effect. IV access is in situ. What is the most appropriate next step?

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Correct answer: B — IV levetiracetam

For established status epilepticus refractory to two doses of benzodiazepine, second-line agents include IV levetiracetam, IV phenytoin/fosphenytoin, or IV sodium valproate. The ESETT trial (referenced in RCH CPG) showed equivalent efficacy of these three agents. Levetiracetam is increasingly preferred due to its safety profile.

Reference: RCH Melbourne – 2024 – Seizures Acute Management CPG; Chamberlain JM et al – 2020 – ESETT Trial (Lancet)