What is the initial treatment for status epilepticus when intravenous access is available?

What is the initial treatment for status epilepticus when intravenous access is available?

• A. IV Diazepam
• B. Oral Valproate
• C. IV Lorazepam
• D. IV Phenytoin

Answer: (C)

In convulsive status epilepticus with IV access, the priority is rapid termination of seizures with a benzodiazepine. IV lorazepam is the best initial choice because it acts quickly and provides a longer duration of anticonvulsant effect compared with other benzodiazepines like diazepam, which, although fast-acting, redistributes quickly and often requires redosing. Lorazepam binds GABA-A receptors to enhance inhibitory neurotransmission, stopping the seizure promptly and more reliably. A typical approach is lorazepam 0.1 mg/kg IV (max around 4 mg), with a possible repeat dose if seizures continue after a few minutes. If seizures persist after benzodiazepines, proceed to second-line agents such as fosphenytoin or valproate for ongoing control, and escalate to more intensive therapies if refractory.

In convulsive status epilepticus with IV access, the priority is rapid termination of seizures with a benzodiazepine. IV lorazepam is the best initial choice because it acts quickly and provides a longer duration of anticonvulsant effect compared with other benzodiazepines like diazepam, which, although fast-acting, redistributes quickly and often requires redosing. Lorazepam binds GABA-A receptors to enhance inhibitory neurotransmission, stopping the seizure promptly and more reliably.

A typical approach is lorazepam 0.1 mg/kg IV (max around 4 mg), with a possible repeat dose if seizures continue after a few minutes. If seizures persist after benzodiazepines, proceed to second-line agents such as fosphenytoin or valproate for ongoing control, and escalate to more intensive therapies if refractory.