What is the first line of treatment in a patient experiencing status epilepticus?

In the management of status epilepticus, the first-line treatment is intravenous (IV) benzodiazepines. This approach is preferred due to the rapid onset of action of benzodiazepines, which can quickly terminate ongoing seizures. Medications such as lorazepam or diazepam are commonly utilized in this setting.

The urgency of stopping seizures in status epilepticus is critical, as prolonged seizure activity can lead to significant morbidity, including neuronal injury and other complications. Benzodiazepines act on the GABA-A receptor, enhancing inhibitory neurotransmission, which is essential in controlling seizure activity.

In contrast, phenytoin infusion is not the first line due to its slower onset compared to benzodiazepines. While phenytoin may be used in the subsequent stages of treatment for seizure prophylaxis, it is not effective at terminating active seizures rapidly. Oral benzodiazepines are unsuitable for immediate treatment in the emergency setting given the need for rapid intervention via IV administration. Immediate surgical intervention is rarely the first step in the management of status epilepticus unless there is an identifiable structural cause such as a mass lesion or hemorrhage present. Thus, IV benzodiazepines are the standard of care for acute scenarios requiring quick