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Convulsive status epilepticus — MCCQE Part 1 MCQ

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HardSeizuresConvulsive status epilepticusMCCQE Part 1

A 40-year-old man has an ongoing generalized tonic-clonic seizure 8 minutes after onset in the emergency department. Airway support and cardiorespiratory monitoring are in place, fingerstick glucose is 5.4 mmol/L, and intravenous access is functioning. No antiseizure medication has yet been given. Which management sequence is most appropriate?

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Correct answer: E — Give IV lorazepam now and prepare an IV second-line antiseizure drug

Continuous convulsive activity beyond 5 minutes is status epilepticus and should be treated immediately because spontaneous termination becomes less likely and morbidity rises with duration. With IV access available, IV lorazepam is an appropriate first-line abortive benzodiazepine while airway, breathing and circulation are supported and monitored. A second-line IV antiseizure drug should be prepared promptly because it is needed to prevent recurrence and must be administered without delay if seizure activity persists. Neuroimaging and evaluation of the cause follow stabilization and seizure control unless a simultaneous life-threatening indication dictates otherwise. Fosphenytoin is a second-line rather than first-before-benzodiazepine drug in this sequence; oral carbamazepine is unsuitable during an active convulsion, and treatment must not wait for 30 minutes.

Reference: Emergency Care BC, Seizure in Adults: https://emergencycarebc.ca/clinical_resource/clinical-summary/seizure-in-adults/