A 28-year-old male is brought to the emergency department in continuous generalized tonic-clonic convulsions lasting 25 minutes without regaining consciousness. IV access has been established. What is the first-line medication of choice to terminate this status epilepticus?

Answer and explanation

Correct answer: D. Intravenous Lorazepam

  1. Step 1: Status epilepticus is defined as continuous seizure activity lasting >= 5 minutes or recurrent seizures without full neurological recovery between episodes.
  2. Step 2: Intravenous benzodiazepines (IV Lorazepam 4 mg or IV Diazepam 10 mg) are the first-line pharmacological treatment of choice, providing rapid GABA-A receptor potentiation.
  3. Step 3: Second-line antiepileptic drugs (levetiracetam, fosphenytoin, or valproate) are administered immediately afterward to prevent seizure recurrence.
Answer
Intravenous Lorazepam.
Why not the others: 'Intravenous Levetiracetam' is an evidence-based second-line agent administered if benzodiazepines fail or to maintain seizure control; 'Intravenous Fosphenytoin' is second-line; 'Propofol infusion' is reserved for refractory status epilepticus requiring intubation.

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