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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 24 OF 100
A 29-year-old man with juvenile myoclonic epilepsy presents with a 45-minute history of continuous generalized tonic-clonic seizure activity. His wife reports he missed the last three doses of valproate 1,000 mg twice daily. Which of the following medications is the best choice for emergent pharmacologic therapy?
A. Phenytoin 20 mg/kg IV
B. Valproate 30 mg/kg IV
C. Lorazepam 0.1 mg/kg IV
D. Levetiracetam 2,000 mg IV
E. Diazepam 0.15 mg/kg IV **
** = Your answer
Benzodiazepines are considered first-line therapy for convulsive status epilepticus. Although concurrent administration of an antiepileptic drug may be prudent, initial treatment with a benzodiazepine is the current guideline. Lorazepam is preferred over diazepam due to diazepam’s short duration of action as well as its rapid redistribution to fat stores.
* Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998 Sep 17;330(12):792-798.
* Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3-