Convulsive status epilepticus — MRCEM SBA MCQ

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EasyResuscitation and critical illnessConvulsive status epilepticusMRCEM SBA

A 48-year-old man is brought to the emergency department during a continuous generalised tonic–clonic seizure. The seizure began 16 minutes ago. He received 4 mg of intravenous lorazepam 10 minutes ago, but convulsions have continued without interruption. His capillary glucose is 6.1 mmol/L. Intravenous access, oxygen, monitoring and staff able to support his airway are in place. He has received no other antiseizure medication. Which antiseizure treatment should be given next?

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Correct answer: D — Administer intravenous lorazepam

This is convulsive status epilepticus: the generalised convulsion has continued for substantially longer than five minutes. He has received one benzodiazepine dose, not two, and the seizure remains active 10 minutes later. The next antiseizure treatment is therefore a second intravenous lorazepam dose, with continued airway and cardiorespiratory monitoring and senior support. NICE recommends a second benzodiazepine dose when the seizure has not stopped within 5–10 minutes of the first; intravenous lorazepam is appropriate when intravenous access and resuscitation facilities are available. ([nice.org.uk](https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures)) A and C are credible second-line intravenous treatments, but they are indicated when convulsive status epilepticus persists despite two benzodiazepine doses, not after the single dose given here. B is a benzodiazepine, but the buccal route offers no advantage over intravenous lorazepam with established access and resuscitation facilities. E is a later, specialist-guided option for status epilepticus refractory to second-line treatment. The immediate decision is to complete the benzodiazepine stage promptly while preparing to escalate if the seizure continues. ([nice.org.uk](https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures))

Reference: Epilepsies in children, young people and adults: treating status epilepticus, repeated or cluster seizures, and prolonged seizures (Updated 30 January 2025) — https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures Management of Generalised Status Epilepticus in Adults (Effective October 2022) — https://www.bucksformulary.nhs.uk/docs/Guideline_595FM.pdf