A patient develops prolonged seizure during an ECT session (status epilepticus lasting > 3 minutes). The most appropriate immediate pharmacological intervention is:

• A IV propofol at induction dose to re-anaesthetise and terminate the seizure
• B IV succinylcholine to paralyse the patient
• C Repeat electrical stimulation to produce stimulus-induced seizure termination
• D IV diazepam or lorazepam to terminate the prolonged seizure ✓

Explanation

A prolonged seizure lasting more than 3 minutes during ECT is a medical emergency. The standard management is administration of IV benzodiazepine (diazepam 5–10 mg IV or lorazepam 1–2 mg IV) to terminate the ictal activity. IV propofol can also terminate seizures (and is an alternative), but benzodiazepines are the pharmacological first choice in prolonged ECT-induced seizures. Succinylcholine paralyses peripheral muscles but has no anticonvulsant effect on cerebral seizure activity. Repeat electrical stimulation is not used and would be harmful.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.