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Status epilepticus — ABIM Board MCQ

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HardNeurologyStatus epilepticusABIM Board

A 43-year-old man has generalized convulsive status epilepticus. Intramuscular midazolam terminates visible convulsions briefly, but electroclinical seizure activity recurs while IV access is obtained. Glucose is normal. Which established-status treatment is appropriate now?

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Correct answer: A — Load intravenous levetiracetam as second-line antiseizure therapy

The best answer is “Load intravenous levetiracetam as second-line antiseizure therapy”. After an adequate benzodiazepine, persistent or recurrent status requires prompt loading with a second-line antiseizure medication. Levetiracetam, fosphenytoin, and valproate have comparable efficacy in established convulsive status and selection depends on comorbidity and interactions. Delayed treatment increases the risk of refractory status and neuronal injury.

Reference: American Epilepsy Society Guideline: Convulsive Status Epilepticus: https://pmc.ncbi.nlm.nih.gov/articles/PMC4749120/