For Status epilepticus, treatment of choice is: September 2012
**Core Concept**
Status epilepticus is a medical emergency defined as prolonged seizure lasting more than 5 minutes or recurrent seizures without full recovery between them. The primary goal is rapid termination of seizure activity to prevent brain damage and mortality.
**Why the Correct Answer is Right**
Lorazepam, a benzodiazepine, acts as a positive allosteric modulator of GABA_A receptors, enhancing GABA-mediated inhibition in the central nervous system. It has the fastest onset of action (within 1–3 minutes) and is the first-line treatment for acute seizure control in status epilepticus. It is administered intravenously or intramuscularly in emergency settings due to its rapid bioavailability and efficacy in terminating seizures immediately.
**Why Each Wrong Option is Incorrect**
Option A: Ethosuximide is effective for absence seizures, not generalized or prolonged seizures, and has no rapid action.
Option B: Sodium valproate is used for generalized tonic-clonic and absence seizures but is not first-line in acute status epilepticus due to slow onset and risk of hepatotoxicity.
Option C: Lamotrigine has a delayed onset and is not used as initial treatment for acute seizure control.
**Clinical Pearl / High-Yield Fact**
In status epilepticus, benzodiazepines like lorazepam are the **first-line agents** due to rapid action; if seizures persist, second-line agents like phenytoin or levetiracetam are used. Delaying benzodiazepine administration increases mortality and neurological morbidity.
✓ Correct Answer: D. Lorazepam