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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 94 OF 100
A 47-year-old man with known epilepsy presents with frequent, intermittent confusion but can speak. Family members state he is noncompliant with his antiepileptic medication. Video EEG findings are shown. Which of the following is the most appropriate next step in management?
A. Intubation-ventilation to proceed with more aggressive management
B. Lumbar puncture with subsequent viral polymerase reaction titers
C. MRI of the brain with and without gadolinium administration
D. Administration of IV lorazepam then reinitation of home antiepileptic medication **
E. Further evaluation with paraneoplastic evaluation for malignancy
** = Your answer
The patient is experiencing nonconvulsive status epilepticus. The history of epilepsy, coupled with noncompliance with antiepileptic medications, clinical presentation, and EEG results are diagnostic. Intubation is not required as the patient is maintaining his airway. The most appropriate next step in management is aggressive treatment with appropriate mediations for his nonconvulsive status epilepticus.
* Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012 Aug;17(1):3-23.Cial