A 22-year-old woman with known generalized tonic-clonic epilepsy presents to the emergency department with continuous seizure activity for 18 minutes without recovery of consciousness between episodes. Intravenous access is established. What is the first-line pharmacological treatment in this scenario?

• A Intravenous phenytoin 20 mg/kg
• B Intravenous phenobarbital 20 mg/kg
• C Intravenous lorazepam 0.1 mg/kg ✓
• D Intravenous levetiracetam 60 mg/kg

Explanation

Status epilepticus is defined as seizure activity lasting more than 5 minutes or recurrent seizures without recovery of consciousness. Benzodiazepines (IV lorazepam 0.1 mg/kg, maximum 4 mg per dose) are the first-line treatment in the initial 5-20 minute phase because they act rapidly on GABA-A receptors. Phenytoin/fosphenytoin is second-line. Phenobarbital is third-line. Levetiracetam is sometimes used as adjunctive therapy but is not first-line per current guidelines (Neurocritical Care Society, 2012).

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.