Topic: Seizure
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
After initial resuscitative measures, the preferred medication in this situation is:

Correct Answer : D.

This patient presents in status epilepticus (SE). Although diazepam has long been an effective treatment, lorazepam has emerged as the preferred agent because of pharmacologic properties that should give it a longer duration of action than diazepam.
>Phenytoin and fosphenytoin are limited by potentially serious adverse effects, such as hypotension.
>Intravenous valproic acid has been shown in a pilot study to be equal to or better than phenytoin in aborting generalized SE, and it has been used in some cases of focal status epilepticus
>In some settings where drug intoxication might be likely, consider also adding naloxone. Note: Suspect subtle status epilepticus or transformed status epilepticus in any patient who does not have improving level of consciousness within 20-30 minutes of cessation of generalized seizure activity.