Case 4

An 18 y/o female is brought into the resus room in ED. The paramedics have pre-notified you of her arrival. Her mother reports that she had a 10 minute tonic clonic seizure at home. She was post-ictal on arrival of the paramedics. Prior to regaining consciousness she started to seize again 15 minutes ago. The seizure is ongoing on arrival to resus despite 10mg of buccal midazolam en route.

She has a past history of epilepsy. Her mother is unsure of her compliance with her anti-epileptic drugs.

Question 1

What is the diagnosis?

Question 2

What is the immediate (non-pharmacological) management for this patient?

 Question 3

What is the first line pharmacological management of this condition?

 Question 4

Her seizure activity continues despite this treatment. What is the second line pharmacological management?