The nature of the drug selected must be guided by the clinical situation. If a patient is having a seizure at the time of assessment, a benzodiazepine is needed. If the patient has a history of serial seizures but convulsive seizures have abated, then administration of a long-acting AED is the best choice. The benzodiazepines are effective and highly potent. Diazepam and lorazepam are commonly available.
Diazepam is highly lipid soluble and penetrates the brain rapidly.
However, redistribution into nonneural fatty tissue causes rapid decline in both brain and blood concentrations. If diazepam is used to terminate seizures, a long-acting AED, such as phenytoin, must be administered. The action of lorazepam lasts longer but is associated with a prolonged time to full recovery. Phenytoin Loading patients with phenytoin intravenously will terminate convulsive status epilepticus. Patients with cardiac disease or with difficulty maintaining blood pressure require careful monitoring.