Which of the following is the first-line anticonvulsant in status epilepticus after airway protection?

• A. IV lorazepam
• B. IV phenytoin
• C. IV diazepam
• D. IV valproic acid

Answer: (A)

In status epilepticus, after securing the airway, the priority is rapid termination of seizure activity with a fast-acting anticonvulsant. Benzodiazepines are the first line because they quickly enhance GABAergic inhibition to stop the seizure.

Among the options, intravenous lorazepam is the best first-line choice. It provides a longer-lasting anticonvulsant effect in the CNS, which reduces the chance that the seizure will recur soon after the drug is given. Diazepam, while it acts quickly, is cleared from the brain more rapidly due to redistribution to fat tissue, so its effect doesn’t last as long and seizures can recur. Phenytoin and valproic acid are important later if seizures persist or for maintenance, but they are not the initial rapid-control agent. If lorazepam isn’t available, diazepam can be used, but lorazepam is preferred for ongoing control.