Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment for status epilepticus?

1. Phenytoin

2. Carbamazepine

3. Valproate

4. Lorazepam

The correct answer is: Lorazepam

The first-line treatment for status epilepticus is Lorazepam. This medication is a benzodiazepine that has a rapid onset of action, making it effective in terminating prolonged seizures. Lorazepam works by enhancing the effect of the neurotransmitter GABA, which inhibits excessive neuronal firing, thus providing rapid relief in an acute seizure situation. In the context of status epilepticus, where there is a continuous seizure lasting longer than five minutes, it is critical to act quickly. Lorazepam is favored due to its efficacy and relatively longer duration of action compared to other benzodiazepines. Following the administration of Lorazepam, if seizures persist, additional treatments such as phenytoin or valproate can be considered, but the immediate goal is to stop the seizures as fast as possible to prevent complications such as neuronal injury or even death. When looking at the other options, phenytoin and valproate may be used as second-line treatments, but they do not provide the rapid control that Lorazepam does in emergency situations. Carbamazepine is not typically used in the initial management of acute seizures or status epilepticus due to its slower onset and the nature of its mechanism, making it unsuitable for immediate intervention